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Who Leaves Early? Factors Associated With Against Medical Advice Discharge During Alcohol Withdrawal Treatment

Pytell, Jarratt D., MD; Rastegar, Darius A., MD

doi: 10.1097/ADM.0000000000000430
Original Research

Objective: To determine if certain patient, clinical, and disease factors are associated with against medical advice (AMA) discharge among patients admitted for treatment of alcohol withdrawal.

Methods: Data from admissions to a dedicated unit for treatment of substance withdrawal were collected over a 6-month period. Patients with AMA and planned discharge were compared with regard to demographics, clinical data, and substance use disorder disease characteristics. A stepwise logistic regression was used to find the best model.

Results: The study population included 655 patient encounters. A total of 93 (14%) discharges were AMA. Bivariate analysis showed patients with AMA discharge were younger (mean age 43 vs 46 years; P < 0.05), more likely to leave on a Tuesday to Thursday, and to have an initial withdrawal score at or above the median (AMA 69% vs planned 56%; P = 0.02). Emergency department (ED) admissions had an AMA discharge rate of 21% compared with 10% of community admissions (P < 0.05). Regression analysis found AMA discharge was significantly associated with admission from the ED (odds ratio [OR] 2.03, confidence interval [CI] 1.27–3.25) and younger age (OR 0.97, CI 0.95–0.99). There was no significant difference in discharge disposition among patients with concurrent opioid use disorder who were on opioid agonist therapy.

Conclusions: AMA discharges occurred in 1 of every 7 admissions. Being admitted from the ED and younger age was associated with AMA discharge. No other patient or clinical factors were found to be associated with AMA discharge.

Bayview Internal Medicine Residency Program, Johns Hopkins University School of Medicine, Baltimore, MD (JDP); Center for Chemical Dependence, Johns Hopkins Bayview Medical Center, Baltimore, MD (DAR).

Send correspondence to Jarratt D. Pytell, MD, Bayview Internal Medicine Residency Program, Johns Hopkins University School of Medicine, 4940 Eastern Avenue, Baltimore, MD 21231. E-mail:

Received 31 October, 2017

Accepted 21 April, 2018

Funding: There was no outside funding for this study.

The authors have no disclosures or conflicts of interest.

© 2018 American Society of Addiction Medicine