The following is a summary of the “Factors Associated With a Discharge Against Medical Advice From an Emergency Department in Adult Patients With Appendicitis,” published in the January 2023 issue of Emergency Medicine by Keneally, et al.
Acute appendicitis patients who experience delays in receiving treatment often have poorer outcomes. Therefore, patients must agree to treatment promptly. This study aims to examine whether or not the rates of discharge against medical advice (DAMA) from the emergency room following a diagnosis of acute appendicitis vary by race and socioeconomic status. The 2019 National Emergency Department Sample was used to identify patients retrospectively. Subjects had to be diagnosed with acute appendicitis and be 18 years or older to participate. Chi-square or Fisher’s exact tests were used to compare rates. Using multiple logistic regression, we calculated odds ratios.
The level of statistical significance was set at a P value of 0.05. The prevalence of DAMA was extremely low (0.37%) overall. The rate was highest among Black patients and lowest among White patients (0.72% vs. 0.28%, P< 0.001). With additional factors considered, the odds ratio (OR) for DAMA was still higher among Black patients (1.96, 95% CI, 1.26-2.97). Patients who were male were at greater risk (OR 1.78, 95% CI 1.32-2.41) and had a higher unadjusted rate (0.47% vs. 0.26% in females, P< 0.001). Patients between 30 to 65 years had an increased risk of (OR 1.48, 95% CI 1.10-2.0).
In comparison to patients with private insurance, those with either public or no insurance had significantly higher rates (0.57% and 0.56% vs. 0.23%, respectively, P< 0.001). The risk of developing DAMA increased with age, having no health insurance, being black, and being a man. Patient risk stratification is helpful in figuring out which preventative measures to take. The next step in addressing inequalities in appendicitis care may be to focus on lowering rates of DAMA.
Source: sciencedirect.com/science/article/abs/pii/S0736467922005790
