title: Risk Factors of Discharged Against Medical Advice among Adolescents Self-inflicted Injury and Attempted Suicide in the Korean Emergency Department.
abstract: Suicide is a leading cause of death among Korean adolescents. Many suicide attempting adolescents often are discharged against medical advice in the emergency department. The aim of the present study was to determine the risk factors for discharge against medical advice (DAMA) after self-inflicted injury or attempted suicide in the emergency department. We extracted data on adolescents (10-19 yr old) from the national emergency department information system; we used data from 2007 and 2011. A total of 6,394 adolescents visited EDs after self-inflicted injury or attempted suicide. Among these patients, the median age was 17 yr (Interquatile range, 15-18 yr), 83.2% were between 15-19 yr of age, and 63.3% were female. Poisoning was the most common method of attempted suicide, while hanging and fall were the most common methods of fatality. The rate of DAMA from the ED was 22.8%. Independent risk factors for DAMA included female gender (odds ratio [OR], 1.49), older age adolescents (OR, 1.96), residence in a metropolitan/large city area (OR, 1.49), and discharge at night (OR, 1.38). These risk factors should be considered in establishing management and counseling plans for patients discharged against medical advice by community services and EDs.
authors.affiliation: Department of Emergency Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea.
authors.forename: Jin Hee
authors.initials: JH
authors.lastname: Jung
authors.affiliation: Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea.
authors.forename: Do Kyun
authors.initials: DK
authors.lastname: Kim
authors.affiliation: Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
authors.forename: Jae Yun
authors.initials: JY
authors.lastname: Jung
authors.affiliation: Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea.
authors.forename: Jin Hee
authors.initials: JH
authors.lastname: Lee
authors.affiliation: Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea. ; Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Young Ho
authors.initials: YH
authors.lastname: Kwak
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D003430:Cross-Sectional Studies; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D010351:Patient Discharge / Q000706:statistics & numerical data*; D056910:Republic of Korea; D012189:Retrospective Studies; D012307:Risk Factors; D016728:Self-Injurious Behavior / Q000523:psychology*; D013406:Suicide, Attempted / Q000523:psychology*; D016312:Treatment Refusal / Q000523:psychology*; D055815:Young Adult
keywords: Adolescent; Emergency Service, Hospital; Patient Discharge; Risk Factors; Suicide, Attempted