Clinical and social outcome of children and adolescents presenting in the emergency room for disruptive behavior in Lyon and the Rhône-Alpes region: A multidisciplinary approach

Abstract

Over the last decade, the frequency of emergency room (ER) visits for pediatric psychiatric disorders has increased in the most western countries. Although data available in France is scarce, a similar trend was observed concerning violent or runaway youth. There is no medical consensus on the status and care management of disruptive behavior (DB) in children and adolescents in ER. Seclusion and physical restraint are often requested to treat violence. With a blur lawful framework for minors, such coercive measures raise ethical issues while contradicting the idea of the patients’ autonomy and well-being. Moreover, consulting in the ER for such situations could lead to an inappropriate use of the healthcare system, a poor assessment of associated psychiatric disorders or comorbidities and an underestimation of suicide risk. Thus, the ER visit for a disruptive child or adolescent is characterized by its uncertainty. It represents a situation of heterogeneity in care management as well as a stake of social exclusion and of dangerous behavior.The study aims to:.– analyze these uncertainties by presenting a multidisciplinary and integrative research methodology through combining clinical evidence and social sciences comprehension;– to implement a cohort to describe children and adolescents admitted to the ER for DB (aggressiveness, violence, fugue or theft), their care management and their social and clinical outcome;– to pool these clinical data with an ethnographic fieldwork focused on DB as a “trouble” experienced by various professionals in the ER.We will focus our presentation on these methodological considerations.Disclosure of interestThe authors have not supplied their declaration of competing interest.