Multiple hospital presentations by adolescents who use alcohol or other drugs

FRANÇAIS :
Etude rétrospective des dossiers médicaux, dans 4 hôpitaux de Perth, de 155 adolescents identifiés comme usagers de drogues, pour retrouver sur 12 mois leurs divers accueils en milieu hospitalier. 57% n'ont pas eu d'autres passages à l'hôpital et 7% sont venus pour un suivi de traitement en rapport à leur hospitalisation initiale ; ce sont principalement des usagers d'alcool ou d'alcool et autres drogues. 36% soit 55 adolescents se sont présentés 236 fois à l'hôpital, pour un problème lié à leur usage de drogues. Parmi ces derniers, 39 rendent compte de 147 présentations. En conclusion, les usagers d'alcool sont le groupe le plus accueilli à l'hôpital, mais ce sont les usagers de drogues qui ont des passages multiples.
ENGLISH :
Aims: To investigate 'all cause' and the Subset of 'alcohol or other drug' (AOD) related hospital emergency department (ED) presentations over 12 months by adolescents with a previously identified ACID ED presentation. Design and setting: A retrospective review of medical records in four metropolitan hospitals in Perth, Australia. Participants: One hundred and fifty-two adolescents (13-19 years) identified during a previous 4-week study. The median age was 17.5 (interquartile range (IQR) 16-19): 61 (40%) were female. Method: Medical records were reviewed for the 6 months either side of a pre- viously identified index AOD presentation. Hospital events in this period were collapsed as 'all cause' morbidity with a subclassification of AOD related. Findings: Over half (n = 87,57%) had no additional hospital events and 10 (7%) had only 'follow-up' treatment for their index event. The drug identified for both these groups was primarily alcohol or alcohol plus other drugs compared with mainly heroin or prescription drugs for those with multiple presentations. There were 55 (36%) adolescents who had 236 presentations, including 39 with 147 AOD presentations: six polydrug users accounted for 47% of multiple presentations. Polydrug users had more "all cause" and AOD presentations (Mann-Whitney U = 168.5, P < 0.001) than single drug users, as did 'heroin users' compared with other AOD users (U = 177.5, P < 0.001). There were no significant gender differences in the total number of 'all cause' or AOD presentations. Conclusions: Alcohol users were the largest group at index presentation, but accounted for few of the presentations over 12 months. Polydrug users typically had multiple presentations and may benefit from additional non-medical hospital support. A more labour-intensive and structured approach might help the small number of polydrug users who accounted for a large proportion of repeat presentations over the 12-month period. (Author' s abstract)