Discharge against medical advice from Neonatal Intensive Care Unit: 10 years experience at a University Hospital
Discharge against medical advice from Neonatal Intensive Care Unit: 10 years experience at a University Hospital
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DOI：
10.4103/2230-8229.114774
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发表时间：
2013-05-01
影响因子：
2.7
通讯作者：
Al-Turkistani, Hatim K.
中科院分区：
文献类型：
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作者：
Al-Turkistani, Hatim K.
背景：不顾医疗建议让患者出院是每个年龄段的问题。然而，由于其生理上的脆弱性，新生儿群体在不遵医嘱出院 (DAMA) 时面临的风险更大。本文研究了该问题的普遍性、可能的原因和/或风险因素。材料和方法：对一所大学医院新生儿重症监护病房 (NICU) 不顾医疗建议出院的新生儿 10 年来的病历进行回顾性审查。结果：DAMA 的总体患病率为 1.6%。 51 名不顾医疗建议（AMA）被带出医院的婴儿中，大多数为足月婴儿（72.5%），平均胎龄为 37.78 +/- 2.5 周，出生体重正常，平均体重为 2736 +/- 661 克，沙特阿拉伯人（96%），阴道分娩婴儿（69%），以及临时诊断为新生儿短暂性呼吸急促（TTN）和/或询问的婴儿败血症（49%）。男性和女性之间没有差异（M/F = 1.2）。 DAMA 与 DAMA 时间之间存在关联（周末 DAMA 占 27.5%，5 月至 10 月 DAMA 占 67%）。结论：新生儿的DAMA尤为关键。原因和危险因素很多且难以预测。除了其他几个因素外，其流行还受到一些社会文化信仰的负面影响。
Background: Discharging patients against medical advice is a problem of every age-group. However, because of their physiological vulnerability, the risk for the neonatal population is greater when discharged against medical advice ( DAMA). This article is a study of the prevalence of the problem, the possible causes and/or risk factors. Materials and Methods: A retrospective review of 10 years of medical records of neonates discharged against medical advice from a Neonatal Intensive Care Unit (NICU) at a university hospital. Results: The overall prevalence of DAMA was 1.6%. Most of the 51 infants who were taken out of hospital against medical advice (AMA) were term (72.5%) with a mean gestational age of 37.78 +/- 2.5 weeks, of normal birth weight, with a mean of 2736 +/- 661 g, Saudis (96%), those delivered vaginally (69%), and those that were provisionally diagnosed with transient tachypnea of newborn (TTN) and/or query sepsis (49%). There was no difference between males and females (M/F = 1.2). There was an association between DAMA and the timing of DAMA (27.5% of DAMA at weekends and 67% of DAMA from May to October). Conclusion: DAMA of neonates is particularly critical. The causes and risk factors are many and difficult to predict. In addition to several other factors, its prevalence is influenced negatively by some socio-cultural beliefs.