title: Patients who leave the emergency department against medical advice.
abstract: OBJECTIVE
  Discharge against medical advice (DAMA) from the emergency department (ED) accounts for 0.1% to 2.7% of all ED discharges. DAMA carries a risk of increased mortality and readmissions. Our aim was to investigate the general characteristics of DAMA patients and the differences between them and non-DAMA patients.
  
  
  METHODS
  We reviewed data collected by the National Emergency Medical Center between 2010 and 2011. Subjects were categorized into 2 groups, namely, the DAMA group and the non-DAMA group. We compared these groups with respect to age, gender, trauma or non-trauma status, type of hospital, health insurance, level of consciousness on admission, and diagnosis.
  
  
  RESULTS
  Of 8,000,529 patients, 222,389 (2.78%) left against medical advice. The risk factors for DAMA across all age groups were as follows: no medical insurance (odds ratio [OR], 1.993), initial response to voice (OR, 2.753) or pain (OR, 2.101), trauma admission (OR, 1.126), admission to a local emergency medical center (OR, 1.215), and increased age. A high risk of DAMA was observed among patients with immune, endocrine, psychiatric, neurological, circulatory diseases, and external causes of morbidity and mortality.
  
  
  CONCLUSIONS
  Although DAMA cases account for only a small percentage of hospital discharges, they are important because DAMA patients have high readmission and mortality rates. It is therefore important to understand the general characteristics and predictors of DAMA in order to improve patient outcome and minimize the economic burden on the healthcare system.
authors.affiliation: Department of Emergency Medicine, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Korea.
authors.forename: Choung Ah
authors.initials: CA
authors.lastname: Lee
authors.affiliation: Department of Emergency Medicine, Ajou University School of Medicine, Suwon, Korea.
authors.forename: Joon Pil
authors.initials: JP
authors.lastname: Cho
authors.affiliation: Department of Emergency Medicine, Ajou University School of Medicine, Suwon, Korea.
authors.forename: Sang Cheon
authors.initials: SC
authors.lastname: Choi
authors.affiliation: Department of Emergency Medicine, Ajou University School of Medicine, Suwon, Korea.
authors.forename: Hyuk Hoon
authors.initials: HH
authors.lastname: Kim
authors.affiliation: Department of Emergency Medicine, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Korea.
authors.forename: Ju Ok
authors.initials: JO
authors.lastname: Park
keywords: Emergency service, hospital; Organization and administration; Patient discharge