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Archives de pédiatrie : organe officiel de la Société française de pédiatrie v.24 no.12, 2017년, pp.1214 - 1219   SCIE
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Violent outburst from teenagers in the pediatric emergency room: Complex cases
Agitation des adolescents dans les services d'accueil des urgences pEdiatriques : problEmatique des cas dits ≪ complexes ≫

Cohen, L. (Service de pédiatrie, CHG de Rochefort, 1, avenue Béligon, 17301 Rochefort, France ) ; Gras-Le Guenb, C. (Unité ) ; Fleury, J. (d'accueil des enfants en danger, CHU de Nantes, quai Moncousu, 44093 Nantes cedex 1, France ) ; Caldagues, E. (Unité ) ; Dreno, L. (d'accueil des enfants en danger, CHU de Nantes, quai Moncousu, 44093 Nantes cedex 1, France ) ; Picherot, G. (Service de pédiatrie, CHU de Nantes, 7, quai Moncousu, 44093 Nantes cedex 1, France ) ; Vabres, N. (Unité ) ;
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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.


    REsumE Introduction Les adolescents admis dans les services d’accueil des urgences pEdiatriques (SAUP) pour agitation sont de plus en plus nombreux. Leur agitation, multifactorielle, survient dans un parcours souvent ≪ complexe ≫. Ils mettent en difficultE les structures hospitaliEres d’accueil parfois inadaptEes et dEpassEes par ces moments de crises. L’objectif de cette Etude Etait de recenser et dEcrire la population admise dans un centre hospitalier universitaire (CHU) pour agitation au cours d’une annEe, et de discuter la problEmatique de leur prise en charge. MatEriel et mEthodes Etude rEtrospective de tous les adolescents admis pour agitation, au SAUP du CHU de Nantes, en 2015. REsultats Quatre-vingt-dix-neuf adolescents avaient consultE 182 fois pour agitation. Parmi eux, 85 % avaient des antEcEdents d’agitation, 70 % avaient un suivi psychologique en cours et 56 %, suivis par l’aide sociale A l’enfance, avaient un parcours ≪ complexe ≫. La majoritE des crises Etait survenue au domicile parental et Etait de type hEtEro-agressif. A l’arrivEe au SAUP, 90 % Etaient calmes. La durEe moyenne de sEjour au SAUP avait EtE de 3h42minutes et par la suite 31 % avaient EtE hospitalisEs en pEdiatrie gEnErale, 14 % en pEdopsychiatrie et 8 % en psychiatrie pour adultes. Conclusion La proportion de parcours complexes parmi les adolescents admis aux SAUP Etait importante. Ces adolescents en souffrance, au parcours complexe, illustrent le lien entre violences subies et violences agies. Le dEveloppement d’unitEs d’hospitalisation de courte durEe semble une solution pertinente pour permettre une mise A distance et une Evaluation pluridisciplinaire, somatique, psychique et sociale de ces patients vulnErables.


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