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Master Thesis

Le recours à un service d'urgences pour le patient âgé chuteur est-il justifié, et dans quelle proportion une alternative aux urgences aurait pu être envisagée par le médecin généraliste ?

Abstract : Background: In 2018, elderly over 75 years old represent 9 % of the French population, and also 12% to 25% of all patients consulting in emergency services. Falls constitute their main reason for consultation. Objectives: The main objective was to determine the proportion of elderly people referred for a fall by their general practitioner, and the justification for these consultations, while the secondary objectives focus on the becoming of these patients. Method : between the 01/03/2017 and the 31/05/2017 we performed a descriptive retrospective observational and monocentric study on patient records at the emergency service of the North Hospital of Marseille. We included patients over 75, with the acknowledgment of a fall described in their records. As a primary outcome we chose the justification for consultation at the ER, defined by the presence of one of the seriousness factors of fall recognized by the HAS. Data from the following 4 groups of patient’s referrer were collected and compared: general practitioner, other health professional, non-health professional third party, and patient themselves. Results: among 1691 elderly patients assessing the ER, 389 (23%) sought treatment for a fall and were included. 17 (4,4%) were referred by a general practitioner; 85 (21,8%) were referred by another health professional ; 86 (22,1%) were referred by a non-health professional third party; and 51 (13,1%) came on their own initiative ; the patient’s referrer was unknown for 150 (38,6%) of the patients. The mean age was 85,4 years old [75 – 101]; women represented 70,4% of the patients. 16,3% of the patients resided in nursing home. Patients referred by a GP presented an average of 2,88 ± 1,27 seriousness factors justifying the consultation ; 41,2% of these patients came at least 24 hours after the fall, and 70,6% of them were hospitalized. Conclusion: The consultation at the ER for a fall of patients over 75 when referred by a GP is always legitimate. GP have limited alternatives to the ER. A screening program for fall risking patients could be implemented in order to introduce prevention measures and to decrease their impact. Another solution could be the creation of an emergency service dedicated to elderly patients to unclog adults ER and to permit a more specific care for these frail patients.
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https://dumas.ccsd.cnrs.fr/dumas-02428703
Contributor : Faculté de Médecine Amu <>
Submitted on : Monday, January 6, 2020 - 11:03:51 AM
Last modification on : Wednesday, July 15, 2020 - 3:20:46 PM
Long-term archiving on: : Tuesday, April 7, 2020 - 5:53:45 PM

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Jeremy Cuello. Le recours à un service d'urgences pour le patient âgé chuteur est-il justifié, et dans quelle proportion une alternative aux urgences aurait pu être envisagée par le médecin généraliste ?. Sciences du Vivant [q-bio]. 2018. ⟨dumas-02428703⟩

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