The following is a summary of “Leaving Against Medical Advice From Children’s Hospitals,” published in the October 2024 issue of Pediatrics by Campbell et al.
Leaving the hospital against medical advice (AMA) indicates a breakdown in the family-clinician relationship and presents ethical dilemmas in inpatient pediatric care.
Researchers conducted a retrospective study to analyze the frequency and characteristics of patients who are children leaving against medical advice.
They performed a cohort study of inpatient discharges for children under 18 (January 1, 2018, to December 31, 2022) across 43 children’s hospitals in the Pediatric Health Information System (PHIS) database.
The results showed 3,672,243 inpatient encounters and 2,972 (0.08%) left AMA. Compared with patients who were non-Hispanic White and non-Hispanic Black had higher odds of leaving AMA (aOR]1.31 [95% CI 1.19–1.44]), while Hispanics had lower odds (aOR 0.66 [95% CI 0.59–0.75]). Hospitalizations for patients with noncommercial insurance were more likely to end in leaving AMA. Leaving AMA was associated with increased odds of 14-day inpatient readmission (aOR 1.41 [95% CI 1.24–1.61]). Considerable variability in standardized rates of leaving AMA among hospitals (range 0.18–2.14 discharges per 1,000 inpatient encounters).
The study concluded that approximately 1 in 1,235 pediatric inpatient encounters ended in leaving against medical advice, with increased odds of readmission associated with the decision, and non-Hispanic Black patients had increased odds of leaving AMA.
