Study on demographic factors of discharge against medical advice in pediatric population


  • Vidya B. U. Department of Pediatrics, Father Muller Medical College, Mangalore, Karnataka, India
  • Anil Shetty K. Department of Pediatrics, Father Muller Medical College, Mangalore, Karnataka, India



Discharge against medical advice, Hospital stay, Lumbar puncture, Newborns, Procedure, Phototherapy


Background: Discharge against medical advice (DAMA) is of serious concern among the pediatrics population. Parent(s)/guardians understanding about the disease and various other factors play role in their decision of DAMA. The aim of this study is to know the prevalence of DAMA in a tertiary care center and to observe the gender stratification in DAMA.

Methods: A retrospective survey of medical records of children discharge against medical advice during the period January 2017 to January 2019. Demographic data, length of hospital stay, clinical diagnosis and procedure refused was collected.

Results: Total 12977 were discharged during the study period of which, 387 children were DAMA, prevalence of DAMA was 2.9%, male to female ratio among DAMA patients is 1.2:1. The mean length of stay was 4.8 days. Among the DAMA patients’ newborns were predominant (61.6 %), p value = 0.0001, highly significant. No significant difference with respect to age and gender (p value = 0.535). Out of 370 DAMA patients, 211 patients who required further investigations and procedure was refused by parents/guardians (p value = 0.0001) highly significant. Phototherapy refusal was most common among newborn (59.7%), followed by neuroimaging and lumbar puncture in children (10.9%).

Conclusions: DAMA was observed more among the newborns compared to infants, toddlers and children. Among newborns, phototherapy refusal was most common. In infants and children neuroimaging and lumbar puncture was the most commonly refused procedure. There was no gender bias.


Alfandre DJ. I’m going home. Discharge against medical advice Mayo clinic proceedings. 2009;84(3):255-60.

Roodpeyma S, Hoseyni SAE. Discharge of children from hospital against medical advice. World J Pediatr. 2010;6:353-6.

Hong LE, Ling FC. Discharges of children from hospital against medical advice. J Singapore Paediatr Soc. 1992;34:34-8.

Ibekwe RC, Muoneke VU, Nnebe-Agumadu UH, Amadife MA. Factors influencing discharge against medical advice among paediatric patients in Abakaliki, Southeastern Nigeria. J Tropic Paediatr. 2009;55(1):39-41.

Welcome to census of India: Census India Library. 2020. Available at: Accessed 2 August 2019. 2020. Available at: Accessed 1 August 2019.

Al-Ghafri M, Al-Bulushi A, Al-Qasmi A. Prevalence of and Reasons for Patients Leaving Against Medical Advice from Paediatric Wards in Oman. Sultan Qaboos University Med J. 2016;16(1):e74-7.

Somasetia D, Isman S, Wonoputri N. Discharge against Medical Advice in Pediatric Intensive Care Unit and Subsequent Events. Inter J Integrated Health Sci. 2015;3(1):7-10.

Al-Sadoon M, Al-Shamousi K. Discharge against Medical Advice among Children in Oman: A University Hospital Experience. Sultan Qaboos University Med J. 2013;13(4):534-8.

Ndu IK, Asinobi IN, Ekwochi U, Amadi OF, Osuorah CD, Ayuk AC. Discharge against medical advice (DAMA) among the paediatric age group in Enugu State University Teaching Hospital Parklane, Enugu. J Experimental Res. 2016 Jun;4(1):55-62.






Original Research Articles