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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
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spelling 2026-01-27T16:11:55.1144966 v2 71323 2026-01-27 Characteristics and outcomes of patients who discharge against medical advice from Australian and New Zealand burns services 4bdcc94332b2bd10530c5e71ceb04f14 0000-0001-7096-7688 Belinda Gabbe Belinda Gabbe true false 2026-01-27 MEDS 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.). Journal Article Burns 52 3 107850 Elsevier BV 0305-4179 Burns; Trauma; Burn complications; Rural health; Public health; Discharge planning 1 4 2026 2026-04-01 10.1016/j.burns.2026.107850 COLLEGE NANME Medical School COLLEGE CODE MEDS Swansea University Another institution paid the OA fee 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). 2026-01-27T16:11:55.1144966 2026-01-27T16:01:14.9017068 Faculty of Medicine, Health and Life Sciences Swansea University Medical School - Health Data Science Marcel Chua 0000-0003-0125-3424 1 Lindsay Damkat-Thomas 2 Belinda Gabbe 0000-0001-7096-7688 3 Bronwyn Griffin 0000-0002-6182-9125 4 Courtney Ryder 0000-0001-6511-1965 5 Lincoln M. Tracy 0000-0002-9783-6415 6 71323__36122__12af23d12ecb4b2dba28ce14b3269eb3.pdf 71323.VoR.pdf 2026-01-27T16:08:39.9261904 Output 513445 application/pdf Version of Record true © 2026 The Author(s). This is an open access article under the CC BY license. true eng http://creativecommons.org/licenses/by/4.0/
title Characteristics and outcomes of patients who discharge against medical advice from Australian and New Zealand burns services
spellingShingle Characteristics and outcomes of patients who discharge against medical advice from Australian and New Zealand burns services
Belinda Gabbe
title_short Characteristics and outcomes of patients who discharge against medical advice from Australian and New Zealand burns services
title_full Characteristics and outcomes of patients who discharge against medical advice from Australian and New Zealand burns services
title_fullStr Characteristics and outcomes of patients who discharge against medical advice from Australian and New Zealand burns services
title_full_unstemmed Characteristics and outcomes of patients who discharge against medical advice from Australian and New Zealand burns services
title_sort Characteristics and outcomes of patients who discharge against medical advice from Australian and New Zealand burns services
author_id_str_mv 4bdcc94332b2bd10530c5e71ceb04f14
author_id_fullname_str_mv 4bdcc94332b2bd10530c5e71ceb04f14_***_Belinda Gabbe
author Belinda Gabbe
author2 Marcel Chua
Lindsay Damkat-Thomas
Belinda Gabbe
Bronwyn Griffin
Courtney Ryder
Lincoln M. Tracy
format Journal article
container_title Burns
container_volume 52
container_issue 3
container_start_page 107850
publishDate 2026
institution Swansea University
issn 0305-4179
doi_str_mv 10.1016/j.burns.2026.107850
publisher Elsevier BV
college_str Faculty of Medicine, Health and Life Sciences
hierarchytype
hierarchy_top_id facultyofmedicinehealthandlifesciences
hierarchy_top_title Faculty of Medicine, Health and Life Sciences
hierarchy_parent_id facultyofmedicinehealthandlifesciences
hierarchy_parent_title Faculty of Medicine, Health and Life Sciences
department_str Swansea University Medical School - Health Data Science{{{_:::_}}}Faculty of Medicine, Health and Life Sciences{{{_:::_}}}Swansea University Medical School - Health Data Science
document_store_str 1
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description 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.).
published_date 2026-04-01T05:33:50Z
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