{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T07:40:52Z","timestamp":1777448452499,"version":"3.51.4"},"reference-count":18,"publisher":"SAGE Publications","issue":"10","license":[{"start":{"date-parts":[[2023,5,8]],"date-time":"2023-05-08T00:00:00Z","timestamp":1683504000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["The American Surgeon\u2122"],"published-print":{"date-parts":[[2023,10]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Discharging a patient against medical advice (AMA) is used to describe when a patient opts to leave the hospital prior to a physician\u2019s recommendation while acknowledging the risks of doing so. There are limited published data that identify risk factors for patients leaving AMA, particularly after trauma.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>This study sought to delineate risk factors for AMA discharge after trauma.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Trauma patients who left AMA at our ACS-verified level 1 trauma center were retrospectively included (2021-2022) without exclusions. Demographics, clinical\/injury data, and outcomes were collected. The primary outcome was patient-stated reason for leaving AMA. Study variables were summarized with descriptive statistics.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>During the study period, 262 (8%) of 3218 admitted trauma patients left AMA. Psychiatric disease was present in most patients (n = 197, 75%), including substance abuse (n = 146, 56%), and alcohol abuse (n = 95, 36%). Common patient-stated reasons for leaving AMA were inability\/unwillingness to wait for procedure, imaging, or placement (n = 56, 22%); and psychiatric disease other than alcohol\/substance abuse (n = 39, 15%). Of the patients who left AMA, 29% (n = 77) returned to the hospital 30\u00a0days, and 13% (n = 35) were readmitted.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Patients who leave AMA are at elevated risk of returning to the hospital, which incurs additional costs in already resource-constrained systems. These findings provide impetus for early identification of high-risk patients and efforts to decrease wait times for imaging, procedures, and placement. These actions may mitigate AMA discharges and their resultant impact on patients and hospitals.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/00031348231175487","type":"journal-article","created":{"date-parts":[[2023,5,8]],"date-time":"2023-05-08T06:34:23Z","timestamp":1683527663000},"page":"4000-4006","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Identifying Risk Factors for AMA Discharge After Injury at a Level 1 Trauma Center"],"prefix":"10.1177","volume":"89","author":[{"given":"Chaiss","family":"Ugarte","sequence":"first","affiliation":[{"name":"Division of Acute Care Surgery, LAC+USC Medical Center, University of Southern California, Los Angeles, CA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Morgan","family":"Schellenberg","sequence":"additional","affiliation":[{"name":"Division of Acute Care Surgery, LAC+USC Medical Center, University of Southern California, Los Angeles, CA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shea","family":"Gallagher","sequence":"additional","affiliation":[{"name":"Division of Acute Care Surgery, LAC+USC Medical Center, University of Southern California, Los Angeles, CA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stephen","family":"Park","sequence":"additional","affiliation":[{"name":"Division of Acute Care Surgery, LAC+USC Medical Center, University of Southern California, Los Angeles, CA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Larissa","family":"Epstein","sequence":"additional","affiliation":[{"name":"Division of Acute Care Surgery, LAC+USC Medical Center, University of Southern California, Los Angeles, CA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kazuhide","family":"Matsushima","sequence":"additional","affiliation":[{"name":"Division of Acute Care Surgery, LAC+USC Medical Center, University of Southern California, Los Angeles, CA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matthew J.","family":"Martin","sequence":"additional","affiliation":[{"name":"Division of Acute Care Surgery, LAC+USC Medical Center, University of Southern California, Los Angeles, CA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kenji","family":"Inaba","sequence":"additional","affiliation":[{"name":"Division of Acute Care Surgery, LAC+USC Medical Center, University of Southern California, Los Angeles, CA, 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