[논문]Agitation des adolescents dans les services d’accueil des urgences pédiatriques : problématique des cas dits « complexes »

Cohen, L.; Gras-Le Guenb, C.; Fleury, J.; Caldagues, E.; Dreno, L.; Picherot, G.; Vabres, N.

doi:10.1016/j.arcped.2017.10.001

Agitation des adolescents dans les services d’accueil des urgences pédiatriques : problématique des cas dits « complexes »
Violent outburst from teenagers in the pediatric emergency room: Complex cases

Archives de pédiatrie : organe officiel de la Société française de pédiatrie, v.24 no.12, 2017년, pp.1214 - 1219

Cohen, L. (Service de pé) , Gras-Le Guenb, C. (diatrie, CHG de Rochefort, 1, avenue Bé) , Fleury, J. (ligon, 17301 Rochefort, France) , Caldagues, E. (Unité) , Dreno, L. (d’accueil des enfants en danger, CHU de Nantes, quai Moncousu, 44093 Nantes cedex 1, France) , Picherot, G. (Unité) , Vabres, N. (d’accueil des enfants en danger, CHU de Nantes, quai Moncousu, 44093 Nantes cedex 1, France)

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Summary Introduction Teenagers admitted to the emergency room for a violent attacks episode are increasingly numerous. The source of agitation is multifactorial for these teenagers, often with a complex course. They jeopardize hospital wards, which are often ill-suited for and overwhelmed during these outbursts. This study aims to identify and describe all the teenagers admitted to the hospital over 1 year for a violent outburst and discuss their management. Methods and equipment Retrospective and descriptive study of teenagers admitted to the pediatric emergency department of the Nantes University Hospital for a violent outburst in 2015. Results During this 1-year study, 99 teenagers out of a total of 182 consultations were admitted for a violent outburst. We noted that 85% of them had a previous history of a violent outburst, 70% of them were seeing a psychologist, and 56% were followed by the child welfare services. Most of the outbursts took place at home and were hetero-aggressive. Upon arrival at the pediatric emergency ward, 90% of the teenagers had calmed down. The mean time spent in the emergency ward was 3h42min. Finally, 31% of the teenagers were hospitalized in the general pediatric unit, 14% in the children's psychiatric department, and 8% in the adult psychiatry ward. Conclusion We observed a high proportion of complex cases in the teenagers admitted to our emergency department for a violent outburst. These teenagers in distress, with a complex previous history, illustrated the relation between violence against themselves and their own violent behavior toward others. Developing short-stay units for a temporary isolation could be an advantageous multidisciplinary approach to allow somatic, psychological, and social evaluation of these vulnerable patients.

Abstract

Résumé Introduction Les adolescents admis dans les services d’accueil des urgences pédiatriques (SAUP) pour agitation sont de plus en plus nombreux. Leur agitation, multifactorielle, survient dans un parcours souvent « complexe ». Ils mettent en difficulté les structures hospitalières d’accueil parfois inadaptées et dépassées par ces moments de crises. L’objectif de cette étude était de recenser et décrire la population admise dans un centre hospitalier universitaire (CHU) pour agitation au cours d’une année, et de discuter la problématique de leur prise en charge. Matériel et méthodes Étude rétrospective de tous les adolescents admis pour agitation, au SAUP du CHU de Nantes, en 2015. Résultats Quatre-vingt-dix-neuf adolescents avaient consulté 182 fois pour agitation. Parmi eux, 85 % avaient des antécédents d’agitation, 70 % avaient un suivi psychologique en cours et 56 %, suivis par l’aide sociale à l’enfance, avaient un parcours « complexe ». La majorité des crises était survenue au domicile parental et était de type hétéro-agressif. À l’arrivée au SAUP, 90 % étaient calmes. La durée moyenne de séjour au SAUP avait été de 3h42minutes et par la suite 31 % avaient été hospitalisés en pédiatrie générale, 14 % en pédopsychiatrie et 8 % en psychiatrie pour adultes. Conclusion La proportion de parcours complexes parmi les adolescents admis aux SAUP était importante. Ces adolescents en souffrance, au parcours complexe, illustrent le lien entre violences subies et violences agies. Le développement d’unités d’hospitalisation de courte durée semble une solution pertinente pour permettre une mise à distance et une évaluation pluridisciplinaire, somatique, psychique et sociale de ces patients vulnérables.

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Agitation des adolescents dans les services d’accueil des urgences pédiatriques : problématique des cas dits « complexes »
Violent outburst from teenagers in the pediatric emergency room: Complex cases

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Agitation des adolescents dans les services d’accueil des urgences pédiatriques : problématique des cas dits « complexes » Violent outburst from teenagers in the pediatric emergency room: Complex cases

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Agitation des adolescents dans les services d’accueil des urgences pédiatriques : problématique des cas dits « complexes »
Violent outburst from teenagers in the pediatric emergency room: Complex cases