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Master Thesis

Étude prospective des motivations et des déterminants conduisant les usagers à s’adresser aux urgences pédiatriques du C.H.U. de Bordeaux

Abstract : Introduction: emergency departments, including pediatric emergency departments (PED), have been experiencing uncontrolled growth since their creation, estimated at more than 4% per year in so-called developed countries. This results in a saturation of these departments. The main factor generally evoked to explain this saturation is that they receive between 20% and 50% of patients potentially falling under competencies of general practitioners. Objective: this study aims to study the determinants and motivations that lead users to consult the PED of the University Hospital of Bordeaux on the opening hours of urban medicine offices. Materials and methods: this is a monocentric prospective study using a questionnaire distributed to all accompanying persons presenting themselves to the PED between 8:30 am and 7 pm on eight non-consecutive days. The questionnaire consisted of twenty-five questions aiming to explore the context of the consultation by mean of psycho-socio-educational, socio-economic, geographical and demographic parameters, parameters related to the child's family history, allowing to assess the perception of the emergency by the accompanying person, relating to the confidence that patients have with their doctor. The accompanying person was asked, in the case he was not referred by a doctor, the reason why he presented himself directly to the PED. All of these parameters were evaluated according the CCMU classification established by the physician who took care of the child. Results: we collected 511 passages during our collection period, 451 patients were included. 37.9% of the population is classified as CCMU 1, 44.5% as CCMU 2 and 17.1% as CCMU 3. Trauma, digestive disorders and pain together account for 60% of the reasons for consultation. Only 45% of patients report being referred to the emergency department by a doctor. 47% of patients who are not referred by a doctor usually come to the PED because they consider it is the most appropriate place for the care of their child. Trauma represents 40% of the reasons for consulting of unaddressed patients. 14% of the accompanying persons declare to present themselves to the PED while their child does not seem in danger, 62% whereas their child does not seem in danger but requires, according to them, additional examinations. Only 10% feel that their child is in danger and / or requires hospitalization. Patients classified as CCMU 3 are significantly more often referred by a doctor. We do not identify any psycho-socio-educational or socio-economic parameters that influence the CCMU classification. CCMU 3 class is significantly overrepresented during school holidays. Conclusion: this study confirms the saturation state of the PED of Bordeaux University Hospital, which receives on average one child every 10 minutes and its strong involvement in the care of non-emergency patients. We do not link any psycho-socio-educational or socio-economic parameters to the emergency consultation reason or the CCMU classification. The lack of appropriate and immediate care arrangements in city medicine is the motivation most often reported by users consulting in the emergency department.
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Master Thesis
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Submitted on : Friday, March 13, 2020 - 6:43:27 PM
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Lola Domingues dos Santos. Étude prospective des motivations et des déterminants conduisant les usagers à s’adresser aux urgences pédiatriques du C.H.U. de Bordeaux. Médecine humaine et pathologie. 2019. ⟨dumas-02508115⟩



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