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Year : 2018  |  Volume : 32  |  Issue : 1  |  Page : 18-21

Leaving against medical advice: Pediatric surgical perspective

1 Department of Pediatric Surgery, King George's Medical University, Lucknow, Uttar Pradesh, India
2 Department of Community Medicine, Teerthanthkar Mahavir Medical College and Research Centre, Moradabad, Uttar Pradesh, India

Correspondence Address:
Dr. Anand Pandey
Department of Pediatric Surgery, King George's Medical University, Lucknow - 226 003, Uttar Pradesh
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jms.jms_2_17

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Introduction: There is a paucity of published literature for patients who leave against medical advice (LAMA). There is no such published study conducted in pediatric surgery in India. Materials and Methods: We retrospectively analyzed our records of those patients who left against medical service. We evaluated the records on various parameters such as age at presentation, sex, duration of stay, and any procedure performed. Duration of stay was subdivided into early LAMA (<3 days) or delayed (>3 days). Results: The study period ranged from July 2012 to July 2015. During this period, the total number of admissions was 5604. Of these, 520 (9%) patients left the hospital. Most of the patients were <1 year of age (380, 73%). Male-to-female ratio was 2.9:1. The ratio of emergency to elective admission was 4.4:1. The ratio of patients who left in <3 days to patients who stayed more than 3 days was 3.3:1. Most of the patients had gastrointestinal problems. Four hundred and thirty-nine patients left without any surgical intervention, whereas remaining 81 patients underwent some sort of surgical intervention. The exact cause of LAMA was difficult to ascertain; however, probable causes included cost factor, poor general condition, and dissatisfaction with available resources. Conclusion: LAMA is higher in neonatal period, emergency admission, and within 72 h. Attention toward education, avoiding gender bias, and raising the standards of living may help in accomplishing our goals. A large database of the causes and demographics is important to formulate the measures to minimize it.

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