title: Characteristics of patients with acute traumatic brain injury discharged against medical advice in a level 1 urban trauma centre.
abstract: OBJECTIVE
  To predict which characteristics are associated with patients at risk of discharge against medical advice (AMA).
  
  
  METHODS
  Data were retrospectively collected on individuals (n = 5642) admitted to the Traumatic Brain Injury Program of the MUHC-MGH.
  
  
  METHODS
  Outcome measures used were length of stay (LOS), the Extended Glasgow Outcome Scale (GOSE) as well as the Functional Independence Measure (FIM®).
  
  
  RESULTS
  The overall rate of patients leaving AMA was 1.9% (n = 108). Age was negatively associated with AMA discharge (95% CI OR = [0.966;0.991]). Patients with a history of substance abuse were ∼2-times more likely to leave AMA than those not using substances before injury (95% CI OR = [1.172;3.314]) and the homeless were ∼3-times more likely to leave AMA compared to those who were not homeless (95% CI OR = [1.260;7.138]). Length of stay (LOS) was shorter for patients leaving AMA (p < 0.001) and they showed better outcome (GOSE: p < 0.001; FIM: p = 0.032).
  
  
  CONCLUSIONS
  Knowing the profile of patients with TBI leaving AMA hospitalized in an urban Level 1 Trauma centre will help in the development of effective strategies based on patient needs, values and pre-injury psychosocial situation to encourage them to complete their treatment course in hospital.
authors.affiliation: Neurology and Neurosurgery Department, McGill University Health Centre , Montreal, Quebec , Canada .
authors.forename: Elaine
authors.initials: E
authors.lastname: de Guise
authors.forename: Joanne
authors.initials: J
authors.lastname: LeBlanc
authors.forename: Jehane
authors.initials: J
authors.lastname: Dagher
authors.forename: Simon
authors.initials: S
authors.lastname: Tinawi
authors.forename: Julie
authors.initials: J
authors.lastname: Lamoureux
authors.forename: Judith
authors.initials: J
authors.lastname: Marcoux
authors.forename: Mohammed
authors.initials: M
authors.lastname: Maleki
authors.forename: Mitra
authors.initials: M
authors.lastname: Feyz
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001930:Brain Injuries / Q000453:epidemiology / Q000523:psychology*; D003142:Communication; D003144:Communication Barriers; D005260:Female; D023261:Glasgow Outcome Scale; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010351:Patient Discharge / Q000706:statistics & numerical data; D010359:Patient Readmission; D015995:Prevalence; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012959:Socioeconomic Factors; D019966:Substance-Related Disorders / Q000523:psychology; D014193:Trauma Centers; D016312:Treatment Refusal / Q000523:psychology*
keywords: Discharge against medical advice; Level 1 trauma centre; outcome; traumatic brain injury