Factors Associated With a Discharge Against Medical Advice From an Emergency Department in Adult Patients With Appendicitis

Background: Delays in care can lead to wors-ened outcomes with acute appendicitis. To get timely treat-ment, patients must consent. Objective: To determine if there are racial and socioeconomic differences in discharge against medical advice (DAMA) rates from an emergency department after the diagnosis of acute appendicitis. Meth-ods: Patients were identified retrospectively from the 2019 National Emergency Department Sample. The inclusion cri-teria were patients 18 years of age or older with acute ap-pendicitis. Rates were compared using chi-square or Fisher's exact test. Odds ratios were determined using multiple lo-gistic regression. A p value of 0.05 was used to determine statistical significance. Results: The overall rate of DAMA was low (0.37%). Black patients had the highest rate, and White patients had the lowest (0.72% and 0.28%, respec-tively, p < 0.001). When controlling for covariates, Black patients also had a higher odds ratio (OR) for DAMA (OR 1.96, 95% confidence interval [CI] 1.29-2.97). Male patients had a higher unadjusted rate (0.47% vs. 0.26% in females,p < 0.001) and were at increased risk (OR 1.78, 95% CI 1.32-2.41). Patients between 30 and 65 years old had an increased risk (OR 1.48, 95% CI 1.10-2.0). Patients with government insurance or no insurance had higher rates than private insurance (0.57% and 0.56% vs. 0.23% respectively, p < 0.001). Conclusion: Race, insurance status, age, and male sex were all associated with increase in DAMA. Risk stratifying patients can help to determine how to best employ mitiga-tions strategies. Reducing DAMA may be the next area for improving reducing disparities in appendicitis care.(c) 2022 Elsevier Inc. All rights reserved.