Prevalence and Profile of Discharges without Medical Approval in a West African Pediatric Teaching Hospital, Cote D'ivoire

Introduction: Discharges without medical approval in pediatrics may be life-threatening for the child. The objective of this survey was to determine the prevalence, describe the clinical profile and assess the risk of these premature discharges in hospital pediatric services.

Methods and patients: We conducted a retrospective and descriptive survey between January 1, 2017 and December 31, 2018 in children under 5 admitted in the pediatric service of Yopougon Teaching Hospital. The survey focused on socio-demographic and clinical parameters.

Results: Out of 2354 admissions during the survey period, 202 children were discharged without medical approval, making a prevalence of 8.6%. Among them, 136 left without medical advice (DWMA) and 66 against medical advice (DAMA). The average age was 18.3 months (+/- 13.9). The sex ratio was 1.5. The reasons for consultation were dominated by anemia (44.6%), respiratory distress (9.4%) and febrile convulsions (8.4%). The most common conditions were severe malaria (46.0%), acute lower respiratory infections (18.8%) and severe acute malnutrition (6.9%). Signs of medical emergency were found in 50.0% of the cases at the time of discharge.

Conclusion: Discharges without medical approval represent a worrying situation in a hospital pediatric environment. Discharges circumstances are frequently marked by the existence of signs of life-threatening emergencies, raising a serious ethical issue.

Keywords: Discharge without medical approval, Hospitalization, Children, Cote d’Ivoire.