title: Discharge against medical advice after traumatic brain injury: is intentional injury a predictor?
abstract: BACKGROUND
  Discharge against medical advice (DAMA) have consistently been reported as causing adverse outcomes for both patients and service providers. However, little is known about the DAMA of patients with traumatic brain injury (TBI). The objectives of this study were to develop a risk profile of DAMA patients in the TBI population, to examine factors associated with DAMA occurrence, and to examine specifically whether injury intention (unintentional vs. intentional) is a significant predictor of DAMA.
  
  
  METHODS
  A retrospective cohort study was conducted using hospital discharge data obtained from the Minimal Data Set (MDS) of the Ontario Trauma Registry for the years 1993/1994 and 2000/2001 on TBI patients aged 15 to 64 years.
  
  
  RESULTS
  The MDS review yielded 15,684 cases of TBI with an average length of stay of 2.7 days. Of these, 446 (2.84%) had recorded DAMA events. When compared with patients with unintentional TBI, DAMA was significantly associated with intentional injuries in those with self-inflicted TBI (adjusted odds ratio [aOR] = 1.97; 95% confidence interval [CI], 1.36-2.84) and other-inflicted TBI (aOR = 2.00; CI, 1.53-2.62). DAMA was also associated with younger age and a history of alcohol/drug abuse (aOR = 3.50; CI, 2.85-4.30).
  
  
  CONCLUSIONS
  TBI patients who leave hospital against medical advice are a high-risk population. Early identification of these patients could allow implementation of better prevention and management strategies, thus improving health outcomes and enhancing healthcare delivery.
authors: Graduate Department of Rehabilitation Science, University of Toronto, Toronto, Ontario, Canada. hwan.kim@utoronto.ca
authors: Hwan
authors: H
authors: Kim
authors: Angela
authors: A
authors: Colantonio
authors: Mark
authors: M
authors: Bayley
authors: Deirdre
authors: D
authors: Dawson