Prevalence, causes, and predictors of discharge against medical advice (DAMA) in an emergency setting: an updated systematic review and meta-analysis

Background: The prevalence of discharge against medical advice (DAMA) ranges from 1% to 2% in inpatient admissions and may reach up to 25.9% in some hospitals. The aim of this meta-analysis was to assess the prevalence, causes, and predictors of DAMA in the emergency departments. Methods: We conducted a systematic electronic database search for suitable studies from inception till 20th January 2020 in nine databases. Meta-analysis was used to pool the results. Results: Of the total 180 records screened, we included 14 studies. The overall prevalence rate of DAMA was 6.3% [95% confidence intervals (CI) = 3.41%-11.63%]. The most common cause of DAMA was not being content with the treatment or not agreeing with the diagnosis/treatment (19.93%; 95% CI = 11.02%-33.34%), followed by long waiting time (8.6%; 95% CI = 0.97%-47.45%) and financial problems (7.15%; 95% CI = 1.45-28.78). Regarding predictors, the reported significant unadjusted predictors were local emergency center [Odds ratios (OR) = 1.23%; 95% CI = 1.21-1.24%; p-value < 0.001], regional emergency center (OR = 0.83%; 95% CI = 0.82%- 0.84%; p-value < 0.001), and non-urgent triage (OR = 12.74%; 95% CI = 1.13%-143.97%; p-value = 0.040). In the same context, the significant adjusted predictors were ≤40 years (males) (OR = 3.94%; 95% CI = 1.31%-11.83%; p-value = 0.014), male gender (youth and middle-aged) (OR = 1.2%; 95% CI = 1.19%-1.21%; p-value < 0.001), and Male gender (aged group) (OR = 1.09%; 95% CI = 1.07%-1.11%; p-value < 0.001). Conclusion: DAMA prevalence in emergency departments is high. More attention should be devoted to those patients in relation to the possible DAMA causes for decreasing negative consequences resulted from committing DAMA.