title: Uncompleted emergency department care: patients who leave against medical advice.
abstract: OBJECTIVE
  To compare the patient characteristics, clinical conditions, and short-term recidivism rates of emergency department (ED) patients who leave against medical advice (AMA) with those who leave without being seen (LWBS) or complete their ED care.
  
  
  METHODS
  All eligible patients who visited the ED between July 1, 2004, and June 30, 2005 (N = 31,252) were classified into one of four groups: 1) AMA (n = 857), 2) LWBS (n = 2,767), 3) admitted (n = 8,894), or 4) discharged (n = 18,734). The patient characteristics, primary diagnosis, and 30-day rates of emergent hospitalizations, nonemergent hospitalizations, and ED discharge visits were compared between patients who left AMA and each of the other study groups. A Cox proportional hazards model was used to examine the influence of study group status on the risk of emergent hospitalization, adjusted for patient characteristics.
  
  
  RESULTS
  Patients who left AMA were significantly more likely to be uninsured or covered by Medicaid compared with those admitted or discharged (p < 0.001). The AMA visit rates were highest for nausea and vomiting (9.7%), abdominal pain (7.9%), and nonspecific chest pain (7.6%). During the 30-day follow-up period, patients who left AMA had significantly higher emergent hospitalization and ED discharge visit rates compared with each of the other study groups (p < 0.001). Insurance status, male gender, and higher acuity level were also associated with a significantly higher emergent hospitalization rate.
  
  
  CONCLUSIONS
  Patients who leave AMA may do so prematurely, as evidenced by higher emergent hospitalization rates compared with those who LWBS or complete their care.
authors.affiliation: Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Ru
authors.initials: R
authors.lastname: Ding
authors.forename: Julianna J
authors.initials: JJ
authors.lastname: Jung
authors.forename: Thomas D
authors.initials: TD
authors.lastname: Kirsch
authors.forename: Frederick
authors.initials: F
authors.lastname: Levy
authors.forename: Melissa L
authors.initials: ML
authors.lastname: McCarthy
mesh_terms: D000293:Adolescent; D000328:Adult; D015142:Baltimore / Q000453:epidemiology; D015331:Cohort Studies; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D038801:International Classification of Diseases; D008297:Male; D017057:Medically Uninsured / Q000706:statistics & numerical data; D008875:Middle Aged; D010351:Patient Discharge / Q000706:statistics & numerical data; D010359:Patient Readmission / Q000706:statistics & numerical data; D016016:Proportional Hazards Models; D044469:Racial Groups / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012307:Risk Factors; D012959:Socioeconomic Factors; D016312:Treatment Refusal / Q000706:statistics & numerical data*; D014850:Waiting Lists