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[A CHILD IS LOST: THE PHENOMENON OF REFUSING TO BE HOSPITALIZED IN FAMILIES OF CHILDREN REFERRED TO THE DEPARTMENT OF EMERGENCY MEDICINE].

BACKGROUND
Discharge against medical advice (DAMA) in pediatrics may endanger the child, increase the rate of complications, morbidity or mortality. Despite the prevalence of this phenomenon in the world, we found only one study that examined the DAMA phenomenon in Israel. The study examined the phenomenon in one ER in general and did not distinguish between adults and children.


OBJECTIVES
To describe the characteristics of children and parents who left the ER against medical advice for hospitalization and to examine the reasons given by the parents, and factors associated with this phenomenon.


METHODS
A prospective study involving parents who refused to hospitalize their children despite a medical recommendation. Data was collected from medical records and telephone interviews after discharge.


RESULTS
During the study, there were 16,376 visits to the pediatric ER, 3288 recommendations for hospitalization (20.07%) and 200 DAMA (6%). Reasons for parents refusing hospitalization can be categorized according to: child's health reasons, parents personal reasons and reasons related to the health system`s function. A total of 22 of the children returned to the ER for the same complaint and 12 of them were hospitalized (7.9% of the children who completed their participation in the study).


DISCUSSION
Refusal of medical care for children is a disturbing phenomenon due to the negative consequences that may result from this. In order to minimize the extent of DAMA and its damage, it is very important to recognize the extent and understand the factors associated with this phenomenon.