title: Risk of repeat visits, hospitalisation and death after uncompleted and completed visits to the emergency department: a prospective observation study.
abstract: OBJECTIVE
  The needs of patients with uncompleted visits to the emergency department (ED) are uncertain. The aim was to evaluate ED patients who leave against medical advice (AMA) and who leave without being seen (WBS) regarding repeat ED visits, hospitalisation and mortality within 30 days.
  
  
  METHODS
  The National University Hospital operates the only ED for adults in the capital area of Reykjavik. The source of data was the electronic records for patients 18 years or older, who left AMA, who left WBS, who had the ICD-10 code Z53.2, or who completed their visits. ED visits, hospital admissions and the death registry are filed with the personal identification number, which enabled recognition of the index visit, and the outcomes, rates of return visits, hospitalisation and death.
  
  
  RESULTS
  Of 107 119 patients, 77 left AMA, 4471 left WBS and 423 had code Z53.2. The HR for returning to the ED within 30 days was 4.79 for AMA patients, 4.84 for WBS patients and 3.67 for Z53.2 patients. The HR for hospitalisation within 30 days was 6.90 for AMA patients, 1.09 for WBS patients and 1.07 for Z53.2 patients. The HR for death within 30 days was 10.97 for AMA patients, 0.84 for WBS and no deaths occurred among Z53.2 patients.
  
  
  CONCLUSIONS
  During 30 days follow-up, AMA and WBS patients had an increased rate of repeat ED visits compared with those patients who completed their ED visits. AMA patients also had an increased rate of hospitalisations.
authors.affiliation: Department of Mathematics, University of Iceland, Reykjavik, Iceland.
authors.forename: Oli Pall
authors.initials: OP
authors.lastname: Geirsson
authors.forename: Oddny Sigurborg
authors.initials: OS
authors.lastname: Gunnarsdottir
authors.forename: Jon
authors.initials: J
authors.lastname: Baldursson
authors.forename: Birgir
authors.initials: B
authors.lastname: Hrafnkelsson
authors.forename: Vilhjalmur
authors.initials: V
authors.lastname: Rafnsson
mesh_terms: D000328:Adult; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007055:Iceland; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011446:Prospective Studies; D012307:Risk Factors; D016312:Treatment Refusal / Q000706:statistics & numerical data*; D055815:Young Adult