Injury Characteristics and Request for Discharge against Medical Advice among Road Trauma Patients | Chapter 10 |Medical Science: Updates and Prospects Vol. 3

 

Background: Discharge Against Medical Advice (DAMA) occurs when a patient leaves the hospital contrary to the managing physician's recommendation. DAMA, with its attendant effects of increased healthcare cost and mortality, is common globally. Therefore, DAMA must be continuously brought into public discourse, and strategies to address it should be explored.

 

Aim: The aim of this study was to highlight the Patterns of injuries by Road Traffic Accident victims, the implications of discharge against Medical Advice on certain critical injuries, and the importance of follow-up.

 

Methods: A retrospective study was carried out at the Federal Medical Centre Makurdi, a tertiary health facility in North Central Nigeria, from January 2021 to March 2022. Medical records (case notes) of 121 patients who were involved in Road Traffic Accidents (RTAs), and were admitted either into the ward through the Accident and Emergency Unit, or at the Accident and Emergency Unit of the hospital, were retrieved and analyzed against such variables as age, sex, occupation, resident, types of injury, and length of hospital stay.  Descriptive Statistics were deployed using Microsoft Excel and Statistical Package for Social Sciences (SPSS) to analyse the data.

 

Results: DAMA rate was 12.4% (n=15), of which 8 (6.6%) were females, and 7 (5.7%) were males. Head injury was the commonest injury, 8 (53.3%), seen, while musculoskeletal injuries were 7 (46.7%). The majority of the victims, 6, were in the age group, 30-39 years, with an average age of 37.2. Farmers and housewives were the dominant occupational groups involved. The average hospital stay was 6 days. There was no form of health insurance coverage or follow-up protocol.

 

Conclusion: DAMA for critically injured patients is common in our environment, and there is no known established follow-up system. There is no health insurance coverage. Physicians must strive to track and follow up on these patients to improve outcomes.

 

 

Author(s) Details

Suega P. Inunduh
Department of Human Anatomy/Surgery, Veritas University Abuja, Nigeria.

 

Anthony A. Amuta
Department of Surgery, Federal Centre Makurdi, Nigeria.

 

 

Please see the book here :- https://doi.org/10.9734/bpi/msup/v3/6808

Assessing Acute Stress Disorder in Trauma Patients: The Role of the National Stressful Events Survey Acute Stress Disorder Short Scale (NSESSS) Tool | Chapter 11 | Medical Science: Trends and Innovations Vol. 10

Introduction: Acute Stress Disorder (ASD) is a reaction to stress that is experienced three days to four weeks after a traumatic event. ASD causes symptoms like distractibility, irritability, and emotional detachment, lasting three days to one month after a traumatic event. In 2021, about 40 million emergency department (ED) visits were recorded for acute injuries, highlighting the need for stress quantification. The National Stressful Events Survey Acute Stress Disorder Short Scale (NSESSS) measures ASD severity in adults following extreme stress, with scores ≥14 indicating severe symptoms. Few studies have examined the NSESSS for trauma patients. The purpose of this research is to assess the prevalence of ASD and the predictability of the NSESSS tool in assessing the treatment progress of ASD in trauma patients.

Methods: This descriptive study was conducted at a community hospital. Participants were at least 18 years old, arrived at the ED for acute injuries between January 2021 and December 2023, and were seen by the trauma team. The trauma team, at the local hospital sent a referral to psychiatry if trauma was involved. There was no exclusion criterion. The inclusion criterion only included that participants had to be 18 years of age and older and were diagnosed with an extremely stressful event or experience if trauma was involved by the trauma team providers.  Social workers administered the NSESSS upon hospital arrival, followed by a psychiatric evaluation within 48 hours. Patients were then reassessed by a psychiatrist with the NSESSS and DSM-5 criteria within seven days, with phone follow-ups for those discharged earlier. Statistical analysis was performed using SPSS software.

Results: The study included 27 patients, 17 (63%) of whom were male, and 9 (27%) had pre-existing psychiatric comorbidities. The median age was 41 years (IQR 27-54), and the median NSESSS score was 6 (IQR 2-15). Among participants, 8 were true positives (NSESSS score ≥14 and met ASD DSM-5 criteria), 17 were true negatives (NSESSS score <14 and did not meet ASD DSM-5 criteria), and 2 were false negatives (NSESSS score <14 but met ASD DSM-5 criteria). There were no false positives. Prior studies suggest acute stress disorder affects 21%-24% of adults with an increased prevalence in women. After receiving a diagnosis, an estimated 57% of males and 92% of females go on to develop PTSD within 6 months. (9). The exact reason why most people recover after a traumatic event is unclear.

Conclusion: The NSESSS is a promising tool for assessing ASD severity and tracking treatment progress in trauma patients. Early recognition and intervention for ASD are crucial in mitigating long-term adverse outcomes, highlighting the need for further research to understand its impact on patient well-being.

 

Author (s) Details

Shah, Payas
Tower Health Reading Hospital, West Reading, PA, USA.

 

Vij, Anuj
Tower Health Reading Hospital, West Reading, PA, USA.

 

Villa, Nicole Ann E
Drexel University College of Medicine, West Reading, PA, USA.

 

Espiridion, Eduardo
Tower Health Reading Hospital, West Reading, PA, USA and Drexel University College of Medicine, West Reading, PA, USA.

 

Please see the book here:- https://doi.org/10.9734/bpi/msti/v10/4700