title: Nine-year change of mortality and discharge against medical advice among major trauma patients in a Chinese Intensive Care Unit.
abstract: BACKGROUND
  The mortality/morbidity of patients can be used to evaluate the quality of a trauma care, which can be influenced by incidence of discharge against medical advice (DAMA).
  
  
  OBJECTIVE
  This study was to investigate annual changes of mortality/morbidity and DAMA of trauma patients in one Chinese Intensive Care Unit (ICU) in 9 years.
  
  
  METHODS
  A retrospective analysis of data [age, Injury Severity Score (ISS), Acute Physiology and Chronic Health Evaluation II (APACHE II), Glasgow Coma Scale (GCS), mortality rate, and DAMA] was performed with trauma patients admitted in the emergency ICU of the Second Affiliated Hospital of Zhejiang University from 2003 to 2011.
  
  
  RESULTS
  The rate of total mortality (in-hospital death and dying at discharge) was 6.9 % and the rate of DAMA (deterioration at discharge and improvement at discharge) was 6.6 %. The mortality rate was significantly decreased from 11.1 to 4.6 %, and the rate of deterioration at discharge was increased from 2.8 to 6.4 %. Among the three periods (2003-2005, 2006-2008, and 2009-2011), the age and APACHE II score of patients in total death, deterioration at discharge, and death plus deterioration at discharge groups were highest in the period 2009-2011, whereas the GCS was statistically lower in all groups except in the deterioration at discharge group.
  
  
  CONCLUSIONS
  The medical quality of trauma care has been improved through gradual improvement of instruments and trained medical staffs. The rate of deterioration at discharge was increased, especially in elder patient group. The DAMA had a significant impact on the accurate assessment of trauma care, which should be paid more attention on its potential roles in the future.
authors.affiliation: Department of Emergency Medicine, Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, 310009, Zhejiang, People's Republic of China.
authors.forename: L
authors.initials: L
authors.lastname: Ba
authors.affiliation: Department of Emergency Medicine, Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, 310009, Zhejiang, People's Republic of China.
authors.forename: M
authors.initials: M
authors.lastname: Zhang
authors.affiliation: Department of Emergency Medicine, Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, 310009, Zhejiang, People's Republic of China.
authors.forename: L
authors.initials: L
authors.lastname: Su
authors.affiliation: Emergency Department, Ningxia Medical University, Yinchuan, 750000, People's Republic of China.
authors.forename: Z
authors.initials: Z
authors.lastname: Cheng
authors.affiliation: Department of Emergency Medicine, Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, 310009, Zhejiang, People's Republic of China. xuyongan2000@hotmail.com.
authors.forename: Y
authors.initials: Y
authors.lastname: Xu
mesh_terms: D018806:APACHE; D000058:Accidental Falls / Q000401:mortality; D000063:Accidents, Traffic / Q000401:mortality; D000328:Adult; D000368:Aged; D002681:China / Q000453:epidemiology; D005260:Female; D015600:Glasgow Coma Scale; D017052:Hospital Mortality / Q000639:trends*; D006785:Hospitals, University; D006801:Humans; D015601:Injury Severity Score; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends; D010351:Patient Discharge / Q000639:trends*; D019984:Quality Indicators, Health Care; D011787:Quality of Health Care; D012044:Regression Analysis; D012189:Retrospective Studies; D016312:Treatment Refusal / Q000639:trends*; D014947:Wounds and Injuries / Q000453:epidemiology / Q000401:mortality*
keywords: Discharge against medical advice; Intensive care unit; Mortality; Trauma