{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,5,14]],"date-time":"2025-05-14T03:34:08Z","timestamp":1747193648824,"version":"3.40.5"},"reference-count":12,"publisher":"S. Karger AG","issue":"4","license":[{"start":{"date-parts":[[2023,9,21]],"date-time":"2023-09-21T00:00:00Z","timestamp":1695254400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/karger.com\/pages\/terms-and-conditions"},{"start":{"date-parts":[[2023,9,21]],"date-time":"2023-09-21T00:00:00Z","timestamp":1695254400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/karger.com\/pages\/terms-and-conditions"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cerebrovasc Dis"],"published-print":{"date-parts":[[2024]]},"abstract":"<b><i>Introduction:<\/i><\/b> Patients discharged against medical advice have been shown to have worse outcomes across a host of different conditions. However, risk factors related to increased odds of discharge against medical advice remain understudied in patients who suffer from acute cerebral infarction. <b><i>Methods:<\/i><\/b> We retrospectively examined the 2019 National Emergency Department Sample Database for stroke patients. Multivariable logistic regression was used to estimate associations between patient- and hospital-level factors and the outcome of discharge against medical advice. <b><i>Results:<\/i><\/b> Of the 603,623 encounters for acute ischemic stroke, 8,858 (1.5%) were discharged against medical advice. Predictors of discharge against medical advice were lower income quartile and having either Medicaid insurance (odds ratio [OR] 1.32, 95% confidence interval [CI]: 1.10\u20131.58) or being uninsured (OR 1.28, 95% CI: 1.03\u20131.58). Vascular comorbidities associated with discharge against medical advice included prior tobacco use (OR 1.60, 95% CI: 1.45\u20131.78) and coronary artery disease (OR 1.19, 95% CI: 1.04\u20131.35). Treatment with thrombectomy (OR 0.33, 95% CI: 0.13\u20130.78) or systemic thrombolysis (OR 0.39, 95% CI: 0.23\u20130.66) was inversely associated with discharge against medical advice. A high modified Charlson comorbidity index (3+ vs. 0, OR 0.49, 95% CI: 0.42\u20130.56) was also associated with a lower odds of discharge against medical advice. Presenting to a Northeastern hospital had the highest rate of discharge against medical advice, when compared to other regions (<i>p<\/i> &lt; 0.05). <b><i>Conclusions:<\/i><\/b> Certain patient-level, socioeconomic, and regional factors were associated with discharge against medical advice following acute stroke. These patient- and systems-level factors warrant heightened attention in order to optimize acute care and secondary prevention strategies. <\/jats:p>","DOI":"10.1159\/000531515","type":"journal-article","created":{"date-parts":[[2023,10,11]],"date-time":"2023-10-11T21:03:05Z","timestamp":1697058185000},"page":"365-371","source":"Crossref","is-referenced-by-count":1,"title":["Factors Associated with Discharge against Medical Advice among Acute Stroke Patients: Analysis of the Nationwide Emergency Department Sample"],"prefix":"10.1159","volume":"53","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4133-2143","authenticated-orcid":false,"given":"Karan","family":"Patel","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kamil","family":"Taneja","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1656-6204","authenticated-orcid":false,"given":"Jared","family":"Wolfe","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Solomon","family":"Oak","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christopher","family":"Favilla","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"James E.","family":"Siegler","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"127","published-online":{"date-parts":[[2023,9,21]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.2006.100164"},{"key":"ref2","doi-asserted-by":"publisher","DOI":"10.3390\/healthcare9020111"},{"key":"ref3","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0024459"},{"key":"ref4","doi-asserted-by":"publisher","DOI":"10.1186\/s12873-021-00422-6"},{"key":"ref5","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000001052"},{"key":"ref6","doi-asserted-by":"publisher","DOI":"10.1016\/0895-4356(92)90133-8"},{"key":"ref7","doi-asserted-by":"publisher","DOI":"10.1111\/1475-6773.13306"},{"key":"ref8","doi-asserted-by":"publisher","DOI":"10.4103\/jfmpc.jfmpc_797_19"},{"key":"ref9","doi-asserted-by":"publisher","DOI":"10.1111\/j.1742-1241.2002.tb11268.x"},{"key":"ref10","doi-asserted-by":"publisher","DOI":"10.1007\/s11606-020-06366-0"},{"key":"ref11","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCOUTCOMES.111.000303"},{"key":"ref12","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.114.007542"}],"container-title":["Cerebrovascular Diseases"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/karger.com\/ced\/article-pdf\/53\/4\/365\/4262163\/000531515.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/karger.com\/ced\/article-pdf\/53\/4\/365\/4262163\/000531515.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,4,23]],"date-time":"2025-04-23T15:36:09Z","timestamp":1745422569000},"score":1,"resource":{"primary":{"URL":"https:\/\/karger.com\/article\/doi\/10.1159\/000531515"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,9,21]]},"references-count":12,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2024,8,7]]},"published-print":{"date-parts":[[2024,8,7]]}},"URL":"https:\/\/doi.org\/10.1159\/000531515","archive":["Portico"],"relation":{"is-supplemented-by":[{"id-type":"doi","id":"10.6084\/m9.figshare.24174144","asserted-by":"subject"}]},"ISSN":["1015-9770","1421-9786"],"issn-type":[{"type":"print","value":"1015-9770"},{"type":"electronic","value":"1421-9786"}],"subject":[],"published":{"date-parts":[[2023,9,21]]}}}