Incidence and reasons for leave against medical advice among orthopedic and trauma patients at the university college hospital Ibadan

Tolulope O. Ogunrewo, Oluwadayo A. Magbagbeola, Samuel T. Oladejo, Adeoye Allen-Taylor


Background: Leave against medical advice (LAMA) of hospitalized patients is an adverse clinical event in which a patient chooses to leave the hospital before it is medically advisable to do so and it negatively affects the treatment outcome. Because of this, the study was designed to determine the incidence of and indications for LAMA among orthopedic patients who presented at the accident and emergency department of the university college hospital, Ibadan.

Methods: This was a prospective hospital-based study determining the incidence of LAMA among orthopedic patients who presented at the accident and emergency department of the university college hospital, Ibadan between September 2019 and March 2020.

Results: A total of 289 patients with orthopedic conditions presented within the study period and about 12.46% of these LAMA. The male to female ratio observed in this study is 2:1. The age range was between 8 and 93 years. Trauma from motorbike and motor vehicle accidents accounted for over 80% of the etiology. The most important factor influencing LAMA is financial constraints (63.9%) and LAMA was signed mostly by the patients (25%).

Conclusions: LAMA among orthopedic patients in Ibadan is mostly due to financial reasons, therefore, factors that will reduce the cost of management such as the accessibility to health insurance schemes will significantly reduce the incidence of LAMA among orthopedic patients in Nigeria.



LAMA, DAMA, Health insurance scheme

Full Text:



Nasir AA, Babalola OM. Clinical spectrum of discharges against medical advice in a developing country. Indian J Surg. 2008;70(2):68-72.

Franks P, Meldrum S, Fiscella K. Discharges against medical advice: Are race/ethnicity predictors? J Gen Intern Med. 2006;9:955-60.

Alebiosu CO, Raimi TH. A study of hospital patients’ discharge against medical advice in the Ogun State University Teaching Hospital, Sagamu, Nigeria. Niger Med Pract. 2001;40:33-5.

Shirani F, Jalili M, Asl-e-Soleiman H. Discharged against medical advice from emergency department: results from a tertiary care hospital in Tehran, Iran. Eur J Emerg Med. 2010;17(6):318-21.

Onyiriuka AN. Discharge of hospitalized under-fives against medical advice in Benin City, Nigeria. Niger J Clin Pract. 2007;10(3):200-4.

Stern TW, Silverman BC, Smith FA, Stern TA. Prior discharges against medical advice and withdrawal of consent: what they can teach us about patient management. Prim Care Companion CNS Disord. 2011;13(1): PCC.10f01047.

Alfandre DJ. “I’m going home” discharges against medical advice. Mayo Clinic Proceedings. 2009;84(3):255-60.

Ohanaka EC. Discharge against medical advice. Trop Doct. 2002;32(3):149-51.

Akiode O, Musa AA, Shonubi AM, Salami BA, Oyelekan AA. Trends of discharges against medical advice in a suburban surgical practice in Nigeria. Trop Doct. 2005;35(1):51-2.

Pennycook AG, McNaughton G, Hogg F. Irregular discharge against medical advice from the accident and emergency department – a cause for concern. Emerg Med J. 1992;9(2):230-8.

Moyse HS, Osmum WE. Discharges against medical advice: a community hospital experience. Can J Rural Med. 2004;9(3):148-53.

Jankowski CB, Drum DE. Diagnostic correlates of discharge against medical advice. Arch Gen Psychiatry. 1977;34(2):153-5.

Anis AH, Sun H, Guh DP, Palepu A, Schechter MT, O’Shaughnessy MV. Leaving hospital against medical advice among HIV-positive patients. Can Med Assoc J. 2002;167(6):633-7.

Wong TW, Lee KM, Chan R, Lau CC. A study of patients who leave an accident and emergency department against medical advice. Hong Kong J Emerg Me. 2000;7(1):22-6.

Ngim NE, Nottidge T, Oku A, Akpan AF. Why do orthopaedic trauma patients leave hospital against medical advice? Ibom Med J. 2013;6(1):1-4.

Aliyu ZY. Discharge against medical advice: sociodemographic, clinical and financial perspectives. Int J Clin Pract. 2002;56(5):325-7.

Saitz R. Discharges against medical advice: time to address the causes. Can Med Assoc J. 2002;167(6):647-8.

Udosen AM, Ottei OO, Onuba O. Role of traditional bonesetters in Africa: experience in Calabar, Nigeria. Ann Afr Med. 2006;5(4):170-3.

Thanni LO. Factors influencing patronage of traditional bonesetters. W Afr J Med. 2000;19(3):220-4.

Schlauch RW, Reich P, Kelly MJ. Leaving the hospital against medical advice. N Engl J Med. 1979;300(1):22-4.

Udosen AM, Glen E, Ogbudu S, Nkposong E. Incidence of leaving against medical advice (LAMA) among patient admitted at the accident and emergency unit of the University of Calabar Teaching Hospital, Calabar, Nigeria. Niger J Clin Pract. 2006;9(2):120-3.

Odelowo EO. Factors affecting morbidity and mortality from road traffic accidents: a Nigeria periurban study. Afr J Med Sci. 1993;22(2):69-74.

Eze B, Agu K, Nwosu J. Discharge against medical advice at a tertiary centre in southeastern Nigeria: sociodemographic and clinical dimensions. Patient Intell. 2010;2:27-31.

Ordinioha B. Incidence and reasons for Discharge Against Medical Advice in a tertiary health care facility in Port Harcourt, south-south Nigeria. J Community Med Prim Health Care. 2013;25(2):53-8.