title: The association between acute alcohol consumption and discharge against medical advice of injured patients in the ED.
abstract: OBJECTIVE
  A paucity of data exists on the prevalence and predictors of discharging injured patients against medical advice from emergency departments. The aim of this study is to investigate the association between acute alcohol use and being discharged against medical advice.
  
  
  METHODS
  We performed a prospective, observational study of injured patients enrolled into the Korean Centers for Disease and Prevention injury surveillance program in 7 tertiary, academic, and teaching hospitals from June 1, 2008, to November 31, 2011. Injured patients were assigned to 1 of 3 groups: discharged against medical advice, regular discharge, and transferred or admitted. Multivariable logistic regression models were used to analyze the association between acute alcohol use and being discharged against medical advice.
  
  
  RESULTS
  A total of 125,327 patients were enrolled, and 3473 (2.8%) were discharged against medical advice. The proportion of acute alcohol use was significantly higher among the patients who were discharged against medical advice (40.1%) than the regular discharged (16.6%) or transferred/admitted (15.5%) patients. In a regression model, acute alcohol use increased the risk of being discharged against medical advice (adjusted odds ratio, 1.86; 95% confidence interval, 1.70-2.03). In addition, we identified the interaction between acute alcohol use and intention of injury. Acute alcohol use had a significant association with the discharge against medical advice with the unintentional injury (adjusted odds ratio, 2.56; 95% confidence interval, 2.30-2.84).
  
  
  CONCLUSIONS
  Patients with acute alcohol use before sustaining an injury are at increased risk of being discharged against medical advice from the emergency departments.
authors.affiliation: Department of Emergency Medicine, Seoul National University Bundang Hospital, Gyonggi, Korea. Electronic address: yukijeje@gmail.com.
authors.forename: Joo
authors.initials: J
authors.lastname: Jeong
authors.affiliation: Department of Emergency Medicine, Seoul National University College of Medicine and Hospital, Seoul, Korea. Electronic address: skciva@gmail.com.
authors.forename: Kyoung Jun
authors.initials: KJ
authors.lastname: Song
authors.affiliation: Department of Emergency Medicine, Seoul National University Bundang Hospital, Gyonggi, Korea. Electronic address: myda02@medimail.co.kr.
authors.forename: Yu Jin
authors.initials: YJ
authors.lastname: Kim
authors.affiliation: Department of Emergency Medicine, Gachon University Gil Hospital, Incheon, Korea. Electronic address: truecho@hanmail.net.
authors.forename: Jin Seong
authors.initials: JS
authors.lastname: Cho
authors.affiliation: Hallym University College of Medicine and Hallym University Dongtan Sacred Heart Hospital, Gyounggi, Korea. Electronic address: juok.park@gmail.com.
authors.forename: Ju Ok
authors.initials: JO
authors.lastname: Park
authors.affiliation: Department of Emergency Medicine, Dongkuk University College of Medicine, Ilsan, Kyoung-gi, Korea. Electronic address: scl0126@hanmail.net.
authors.forename: Seung Chul
authors.initials: SC
authors.lastname: Lee
authors.affiliation: Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea. Electronic address: Ro.youngsun@gmail.com.
authors.forename: Young Sun
authors.initials: YS
authors.lastname: Ro
authors.affiliation: Department of Emergency Medicine, UC Davis Medical Center (JFH), Sacramento, CA. Electronic address: jfholmes@ucdavis.edu.
authors.forename: James F
authors.initials: JF
authors.lastname: Holmes
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000435:Alcoholic Intoxication / Q000453:epidemiology*; D015897:Comorbidity; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge / Q000706:statistics & numerical data*; D011159:Population Surveillance; D015995:Prevalence; D011446:Prospective Studies; D056910:Republic of Korea / Q000453:epidemiology; D012307:Risk Factors; D017678:Sex Distribution; D012923:Social Class; D016312:Treatment Refusal / Q000706:statistics & numerical data*; D014947:Wounds and Injuries / Q000453:epidemiology*; D055815:Young Adult