Impact of discharge against medical advice on emergency department revisit among suicide attempters

Objective:
This study examined the clinical effects of discharge against medical advice (DAMA) on suicide reattempts and clarified the risk factors related to DAMA.
Method:
A cross-sectional observational study was conducted in the emergency department (ED) of Chungbuk National University Hospital from 2015 to 2017. The medical records of suicide attempters from the National Emergency Department Information System were reviewed. The primary outcome was the ED revisit rate. The characteristics of the patients associated with DAMA were also examined.
Results:
Among 889 eligible suicide attempters, 328 patients (36.9%) were reported to have DAMA at least once during the study period. Patients who were discharged against medical advice were more likely to reattempt suicide compared to normal disposition patients (11.0% vs. 3.7%, adjusted odds ratio [AOR], 3.002; 95% confidence interval [CI], 1.71-5.28). The independent risk factors for DAMA were age≤60 (AOR, 1.77; 95% CI, 1.20-2.59), female (AOR, 1.45; 95% CI, 1.09-1.91), ED visit at night time (AOR, 1.41; 95% CI, 1.03-1.92), and ED discharge at night time (AOR, 1.40; 95% CI, 1.06-1.85).
Conclusion:
Patients who were discharged against medical advice revisited the ED more after suicide attempts. Public efforts will be needed for patients who are discharged against medical advice considering those risk factors.

Key words: Attempted suicide; Patient discharge; Emergency medical services; Risk factors