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Abstract

ABSTRACT Objectives: To investigate the incidence, parental reasons, and predictors of emergency room (ER) revisits following discharge against medical advice (DAMA) in a pediatric center in Saudi Arabia. Methods: This retrospective cohort study was conducted between January 2020 and December 2024 at a tertiary care hospital. Pediatric patients aged 0-14 years who signed the DAMA during ER visits were included. Medical records of patients with DAMA were reviewed to collect demographic data, diagnoses, reasons for DAMA, and outcomes. Results: Among 446,251 ER visits, 2,336 (0.52%, 95% CI: 0.50%–0.55%) involved caregiver-signed DAMA. These rates ranged from 0.45% (2020) to 0.69% (2023). The majority were Saudi (98.8%), male (55.3%), and under the age of 2 (43.5%). Most patients were triaged three/urgent (63.9%), with infections being the most frequent presenting complaint (52.8%). The documented reasons for DAMA included long waiting times (41.6%) and issues with caregiver availability (18.9%). Within 30 days, 567 patients (24.3%, 95% CI: 22.3%–26.3%) revisited the ER; of these, 33.9% required hospitalization. DAMA was associated with higher revisit risk in children <2 years (OR=1.23, 95% CI: 1.01–1.50) and those presenting with infectious symptoms (OR=1.43, 95% CI: 1.17–1.75). Conclusion: DAMA is a significant challenge in pediatric emergency care. Targeted interventions are crucial for reducing DAMA rates, particularly among high-risk infants and children with infections. Hospitals can improve outcomes by enhancing efficiency, caregiver education, and policies to prevent premature discharge.

Article Type

Research Article

First Page

1487

Last Page

1494

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