Organisation et moyens de l’accueil des urgences pédiatriques : enquête nationale française en 2008

Abstract

Organization and resource utilization of pediatric emergency departments (PEDs) have been poorly evaluated. To assess the access to appropriate pediatric emergency care in France and the degree of preparedness of PEDs and general emergency departments (GEDs) without separate pediatric emergency facilities. A closed-response survey was e-mailed and/or posted to 256hospitals with pediatric wards. A total of 120useable surveys were returned (93% of PEDs and 29% of GEDs). In the PEDs surveyed (n=67, 33university hospitals [UHs] and 34non-university hospitals), disease recruitment was medical and surgical with trauma (84%) or medical only (16%). The medical directors of the PEDs were pediatricians (99%). The average number of visits in 2007was 20,200±10,600per PED (+13% within 5years), and the average number of medical practitioners was 4±3. However, in only 76% of PEDs was at least one pediatrician present after midnight. Medical staffing of PEDs in UHs did not include a pediatric resident in 30% and a pediatric attending physician in 63% of these units. Approximately, 48% of PEDs had a short-stay observation unit (median, five beds). In GEDs (n=53), children were admitted 24h a day in the GED (41%) and directly in the pediatric ward during the day and in the GED at night (28%). Traumas were admitted in 98% of the GEDs. Pediatric coverage 24h a day is still insufficient in PEDs. The training and experience of pediatricians were restricted by the lack of pediatric residency and physician positions in pediatric emergency care. A different access to pediatric emergency care during the day and night was frequent in hospitals without a PED.