BACKGROUND Patients discharged against medical advice have been shown to have worse outcomes across a host of different conditions. However, risk factors related to an increased odds of discharge against medical advice remain understudied in patients who suffer from acute cerebral infarction. METHODS We retrospectively examined the 2019 National Emergency Department Sample Database for stroke patients. Multivariable logistic regression was used to estimate associations between patient- and hospital-level factors and the outcome of discharge against medical advice. RESULTS Of the 603,623 encounters for acute ischemic stroke, 8858 (1.5%) were discharged against medical advice. Predictors of discharge against medical advice were lower income quartile and having either Medicaid insurance (odds ratio [OR] 1.32, 95% confidence interval [CI] 1.10-1.58) or being uninsured (OR 1.28, 95% CI 1.03-1.58). Vascular comorbidities associated with discharge against medical advice included prior tobacco use (OR 1.60, 95%CI 1.45-1.78) and coronary artery disease (OR 1.19, 95% CI 1.04-1.35). Treatment with thrombectomy (OR 0.33, 95% CI 0.13-0.78) or systemic thrombolysis (OR 0.39, 95% CI 0.23-0.66) was inversely associated with discharge against medical advice. A high modified Charlson Comorbidity Index (3+ vs. 0, OR 0.49, 95% CI 0.42-0.56) was also associated with a lower odds of discharge against medical advice. Presenting to a Northeastern hospital had the highest rate of discharge against medical advice, when compared to other regions (p<0.05). CONCLUSIONS Certain patient-level, socioeconomic, and regional factors were associated with discharge against medical advice following acute stroke. These patient and systems-level factors warrant heightened attention in order to optimize acute care and secondary prevention strategies.

中文翻译：

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急性卒中患者不顾医疗建议出院的相关因素：全国急诊科样本分析。

背景技术已证明，不顾医疗建议而出院的患者在许多不同的情况下都有更差的结果。然而，对于急性脑梗死患者，与不遵守医疗建议出院几率增加相关的危险因素仍未得到充分研究。方法我们回顾性检查了2019年国家急诊科脑卒中患者样本数据库。使用多变量逻辑回归来估计患者和医院层面因素与医疗建议出院结果之间的关联。结果 在 603,623 例急性缺血性中风患者中，8858 例 (1.5%) 不顾医疗建议出院。不顾医疗建议出院的预测因素是收入较低的四分位数和拥有医疗补助保险（比值比 [OR] 1.32，95% 置信区间 [CI] 1.10-1.58）或没有保险（OR 1.28，95% CI 1.03-1.58）。与违反医疗建议出院相关的血管合并症包括既往吸烟（OR 1.60，95% CI 1.45-1.78）和冠状动脉疾病（OR 1.19，95% CI 1.04-1.35）。血栓切除术（OR 0.33，95% CI 0.13-0.78）或全身溶栓治疗（OR 0.39，95% CI 0.23-0.66）与不遵医嘱出院呈负相关。高修正查尔森合并症指数（3+ vs. 0，OR 0.49，95% CI 0.42-0.56）也与不顾医疗建议出院的几率较低有关。与其他地区相比，前往东北部医院就诊的不服医嘱出院率最高（p<0.05）。结论 某些患者水平、社会经济和地区因素与急性卒中后不顾医疗建议出院有关。这些患者和系统层面的因素值得高度关注，以优化急性护理和二级预防策略。