Reasons for Early Signing against Medical Advice among Patients Presenting with Extremity Fractures at a Tertiary Hospital Trauma Centre, North-Western Nigeria

Introduction: Signing against medical advice (SAMA) or discharge against medical advice (DAMA) is a fairly common occurrence among patients presenting to trauma with extremity fractures. The study aims to report the reasons for SAMA among these patients. Materials and Methods: This was a retrospective study of 105 admitted patients and later SAMA at the trauma centre of the Usmanu Danfodio University Teaching Hospital (UDUTH), Sokoto, Nigeria between February 2023 and December 2024. The study criteria included all patients with extremity fractures. The reason for SAMA within or more than 24 hours of admission includes the type of fractures (closed fracture, poly-trauma, multiple fractures or open fracture), financial, preference to traditional bone setting or proximity to home. The data analysis was done using SPSS Version 23. Results: There was a total of 105 patients in the study who SAMA. The SAMA prevalence was 3.7%. There were 90 (85.7%) males and 15 (14.3%) females. The mean age of patients was 32±19.55 (range 2 to 85). The most frequent age affected was 25 (9 patients) and the most involved age group was from 20 to 40 years with 54 (51.4%) patients. Eighty-one (77.1%) patients have SAMA within the first 24 hours of admission while 24 (22.9%) SAMA after 24 hours of admission (p-value <0.0001). There were 70 (66.7%) with closed fractures, 19 (18.1%) with polytrauma, 11 (10.5%) with multiple fractures, and 5 (4.8%) with open fractures. The reasons for SAMA were due to financial factors in 66 (62.9%) patients, preference for traditional bone setting (TBS) in 28 (26.7%) patients, and due to being closer to home in 11 (10.5%) patients. Conclusion: This study shows majority of patients had SAMA within the first 24 hours and occurred commonly among younger age groups, male gender, in patients with financial issues, preference for TBS, and closed fractures.