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Master Thesis

Évaluation des pratiques professionnelles concernant la prise en charge des plaies aigües aux urgences de Cayenne

Abstract : Introduction. Wounds are a common reason for admission to emergency departments with 13% of admissions. The management of wounds is consensual and collated in the 2017 SFMU recommendations. French Guiana, by its equatorial location, has many epidemiological features, from a point of view of infectiology and socio-economic fundamentally. The aim of our study is, first of all, to study the epidemiology, and the evolution of acute wounds managed at the Cayenne hospital center and secondly to evaluate the professional practices in relation to the recommendations of SFMU "Acute Wounds in Emergency Structure" 2017. Patients and method. In this prospective, mono-centric, observational study, 183 patients were included over a 2-month period from September 3 to December 3, 2018. 90 could be contacted by phone at a distance from the treatment for an evolution of healing. 93 have been lost. Results. During the collection period, 4920 patients were admitted to the emergency room. Six hundred and twenty-four (12.7%) of the emergency room entries were due to one or more acute wounds. We included 183 patients during the collection period, or 29.3% of all patients with acute wounds. The average age was 31 years (9 months-83 years) and 8.7% had at least one medical CTA. Eighty seven percent (8.7%) had a risk factor for infection and 26.8% of patients received antibiotic treatment with Amoxicillin-clavulanic acid. The predominant locations are head and hands with respectively 33.1% and 32% followed by the lower limbs and feet representing respectively 10.5% and 11%. Ninety-one patients (49.7%) answered the phone call; the others were considered lost after three unsuccessful call attempts. Seventeen point eight percent (17.8%) of the patients who were re-contacted showed signs of superinfection and consulted again with a doctor who gave them antibiotic treatment. The satisfaction rate for healing was 77.8%. Several differences in practices could be highlighted. The use of ATBs, antiseptics, evaluation and burden of pain, the duration of removal of the points and the washing of the wounds mainly. Conclusion. Benign clinical infections have been found in almost one in five patients in care at the Cayenne Hospital. Discrepancies in practice have been highlighted in relation to the reference systems and we have chosen two areas of improvement: the prescription of ATB and the assessment and management of pain. A service protocol will be put in place for these two points. Further studies will be needed to assess the decrease in practice gaps in these two points.
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Master Thesis
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Pierre Lafouasse-Messmer. Évaluation des pratiques professionnelles concernant la prise en charge des plaies aigües aux urgences de Cayenne. Médecine humaine et pathologie. 2019. ⟨dumas-02955398⟩



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