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Characteristics and outcomes of patients who discharge against medical advice from Australian and New Zealand burns services

Marcel Chua Orcid Logo, Lindsay Damkat-Thomas, Belinda Gabbe Orcid Logo, Bronwyn Griffin Orcid Logo, Courtney Ryder Orcid Logo, Lincoln M. Tracy Orcid Logo

Burns, Volume: 52, Issue: 3, Start page: 107850

Swansea University Author: Belinda Gabbe Orcid Logo

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DOI (Published version): 10.1016/j.burns.2026.107850

Abstract

Burns patients with recorded discharges against medical advice (DAMA) face potential medical and financial consequences associated with future readmissions. This study aimed to investigate the characteristics and outcomes of patients with recorded DAMA from burns services in Australia and New Zealan...

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Published in: Burns
ISSN: 0305-4179
Published: Elsevier BV 2026
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URI: https://cronfa.swan.ac.uk/Record/cronfa71323
Abstract: Burns patients with recorded discharges against medical advice (DAMA) face potential medical and financial consequences associated with future readmissions. This study aimed to investigate the characteristics and outcomes of patients with recorded DAMA from burns services in Australia and New Zealand. In an observational study using data from individuals aged ≥ 16 years captured by the Burns Registry of Australia and New Zealand with a burn-related admission between July 2009 and June 2022, 325 patients (1.4 %) had recorded DAMA. A greater proportion of patients with recorded DAMA were aged 30–44 years, of Australian Aboriginal and Torres Strait Islander origin, from outer regional Australia, had pre-existing mental health conditions, with substance use, and sustained their injury through suspected assault or abuse. Injuries in patients with recorded DAMA were more severe. Compared to patients without DAMA, a greater proportion of patients with DAMA were readmitted within 28 days of discharge (13.8 % versus 4.9 %), with failed discharge processes (45.5 %) and infection (18.2 %) being the most frequently recorded reasons. They required readmission to the intensive care unit (20 % versus 8.6 %) with longer lengths of stay. Outcome findings remained similar in a matched cohort analysis between those with and without recorded DAMA. These findings highlight the consequences of DAMA, necessitating primary measures to address modifiable, cultural, and social factors preemptively to prevent DAMA among disadvantaged individuals, and secondary measures to minimize the impact of DAMA (e.g., adequate pain and wound discharge management, follow-up care, community-based treatments, etc.).
Keywords: Burns; Trauma; Burn complications; Rural health; Public health; Discharge planning
College: Faculty of Medicine, Health and Life Sciences
Funders: The BRANZ has received funding from the Australian and New Zealand Burn Association, the Australian Commission on Safety and Quality in Health Care (2008–2009), the Julian Burton Burns Trust (2008–2013), the Helen Macpherson Smith Trust (2010–2012), the Thyne Reid Foundation (2011–2013), the Australasian Foundation for Plastic Surgery (2013–2017), the New Zealand Accident Compensation Corporation (2013–2024), the Clipsal by Schneider Electric National Community Grants Program (2017), the HCF Research Foundation (2018–2019), and the Victorian Agency for Health Information (2021–2022).
Issue: 3
Start Page: 107850

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