Résumé

Introduction: Discharge against medical advice (DAMA) undermines both continuity and safety of care. Little is known about the factors that determine how early trauma patients leave hospital once they have decided to do so. This study aimed to identify the factors independently associated with early DAMA, defined as discharge within the first 24 hours after admission. Methods: We conducted a single-centre, retrospective, observational and analytical study at the Regional Hospital of Ziniaré, Burkina Faso, from 1 December 2021 to 31 December 2025. All records of trauma patients discharged against medical advice were included consecutively. Sociodemographic characteristics, time from injury to hospital admission, mechanism of injury, time from admission to DAMA, the person who made the decision and the reasons for DAMA were analysed. Bivariate associations were tested with the chi-square test or Fisher's exact test. Because late DAMA was infrequent, Firth's penalised logistic regression was used for multivariable analysis. Results: Among the 291 patients included, the mean age was 32.21 ± 16.60 years and 224 (77.0%) were male. The admission-to-DAMA interval was documented for 288 patients: 258 (89.6%) left within the first 24 hours and 30 (10.4%) after 24 hours or more. In bivariate analysis, early DAMA was associated with age per 10-year increment (OR = 0.79; 95% CI: 0.64–0.97), male sex (OR = 4.06; 95% CI: 1.86–8.84), residence in Boussé (OR = 0.19; 95% CI: 0.07–0.53), being a housewife (OR = 0.30; 95% CI: 0.10–0.88), admission within 24 hours of injury (OR = 24.00; 95% CI: 9.23–62.38), domestic accidents (OR = 0.21; 95% CI: 0.07–0.63) and leaving to consult a traditional bone setter (OR = 3.16; 95% CI: 1.42–7.03). After adjustment with Firth regression, only admission within 24 hours of injury remained independently associated with early DAMA (aOR = 5.28; 95% CI: 1.05–26.61; p = 0.044). Conclusion: In this population of trauma patients who left against medical advice, admission within 24 hours of injury was the only factor independently associated with early DAMA. Informing patients and their relatives from the very first hours, and involving the family early in decision-making, may help to limit early departures.

Mot-clés :

Discharge Against Medical Advice, Early Discharge, Trauma, Associated Factors