[The new version of the French teratology information service "CRAT" website]. / La nouvelle version du site internet du Centre de référence sur les agents tératogènes et ses fonctionnalités optimisées.

The Centre de Référence sur les Agents Tératogènes (CRAT) is a unique French national reference center involved in the risk assessment of exogenous agents (mainly drugs, but also medical imaging and addictions) on pregnancy, breastfeeding and fertility. To help improve patient care, CRAT makes its expertise available to healthcare professionals via its website (www.lecrat.fr), a free, independent and public online resource regularly updated by its multidisciplinary team. In December 2023, a new version was launched, based on the evolutions desired by the CRAT team and on a satisfaction survey of website's users. A predictive search bar integrated into the home page now enables users to find the specific information they are looking for more quickly. To optimize the access via smartphones, a mobile version is now available.

[Maternal deaths and management by emergency departments in France 2016-2018]. / Mortalité maternelle et prise en charge par les services d'urgence en France 2016­2018.

In France, 272 maternal deaths occurred during the period 2016-2018, of which 131 were initially treated by healthcare professionals not specialized in obstetric. Fifty-six files were excluded because they did not concern emergency services or because there was insufficient data to allow analysis. Seventy-five cases of maternal deaths initially treated by emergency services (in-hospital emergency department [ED] or emergency medical ambulance [SAMU]) were analyzed. Fifty-six cases were treated by the SAMU and 22 by an ED (both in 3 cases). The causes of death were 20 cardiovascular events, 18 pulmonary embolisms, 9 neurological failures and 8 hemorrhagic shocks. The event occurred during pregnancy in 48 cases (64%) and during per or postpartum period in 27 cases (36%). The motivations for consultation at the ED were mainly pain (n=9), respiratory distress (n=6) or faintness (n=3). The reasons for calling emergency dispatching service (SAMU) were cardiorespiratory arrest in 32 cases (57%) and neurological failure (coma or status epilepticus) in 6 cases (11%). Among the 56 patients treated outside the hospital, 17 died on scene and 39 were transported to a resuscitation room (n=13), a specialized department (n=13), an obstetrics department (n=8) and less often in the ED (n=2). This was considered appropriate in 35 out of 39 cases (90%). Concerning the 75 files analyzed (ED and SAMU), death was considered unavoidable in 37 cases (49%) and potentially avoidable in 29 cases (38%) (maybe=23, probably=6). Avoidability could not be established in 9 cases. Among the 29 potentially avoidable deaths (38%), one of the criteria of avoidability concerned emergency services in 14 cases (ED=9, SAMU/SMUR=5, 18% of the files studied). ED's cares were considered optimal in 11 cases (50%) and non-optimal in 11 cases (50%). SAMU's cares were considered optimal in 45 cases (80%).

Patient opinion and acceptance of emergency department buprenorphine/naloxone to-go home initiation packs.

OBJECTIVES: Many emergency department (ED) patients with opioid use disorder are candidates for home buprenorphine/naloxone initiation with to-go packs. We studied patient opinions and acceptance of buprenorphine/naloxone to-go packs, and factors associated with their acceptance. METHODS: We identified patients at two urban EDs in British Columbia who met opioid use disorder criteria, were not presently on opioid agonist therapy and not in active withdrawal. We offered patients buprenorphine/naloxone to-go as standard of care and then administered a survey to record buprenorphine/naloxone to-go acceptance, the primary outcome. Survey domains included current substance use, prior experience with opioid agonist therapy, and buprenorphine/naloxone related opinions. Patient factors were examined for association with buprenorphine/naloxone to-go acceptance. RESULTS: Of the 89 patients enrolled, median age was 33 years, 27% were female, 67.4% had previously taken buprenorphine/naloxone, and 19.1% had never taken opioid agonist therapy. Overall, 78.7% believed that EDs should dispense buprenorphine/naloxone to-go packs. Thirty-eight (42.7%) patients accepted buprenorphine/naloxone to-go. Buprenorphine/naloxone to-go acceptance was associated with lack of prior opioid agonist therapy, less than 10 years of opioid use and no injection drug use. Reasons to accept included initiating treatment while in withdrawal; reasons to reject included prior unsatisfactory buprenorphine/naloxone experience and interest in other treatments. CONCLUSION: Although less than half of our study population accepted buprenorphine/naloxone to-go when offered, most thought this intervention was beneficial. In isolation, ED buprenorphine/naloxone to-go will not meet the needs of all patients with opioid use disorder. Clinicians and policy makers should consider buprenorphine/naloxone to-go as a low-barrier option for opioid use disorder treatment from the ED when integrated with robust addiction care services.

RéSUMé: OBJECTIFS: De nombreux patients des services d'urgence (SU) atteints d'un trouble lié à la consommation d'opioïdes sont des candidats à l'initiation à la buprénorphine/naloxone à domicile avec des trousses à emporter. Nous avons étudié les opinions des patients et l'acceptation des paquets de buprénorphine/naloxone à emporter, ainsi que les facteurs associés à leur acceptation. MéTHODES: Nous avons identifié des patients à deux urgences urbaines de la Colombie-Britannique qui répondaient aux critères relatifs aux troubles liés à l'utilisation d'opioïdes, qui ne suivaient pas actuellement un traitement aux agonistes des opioïdes et qui n'étaient pas en sevrage actif. Nous avons offert aux patients la buprénorphine/naloxone à emporter comme norme de soins, puis nous avons administré une enquête pour enregistrer l'acceptation de la buprénorphine/naloxone à emporter, le critère de jugement principal. Les domaines d'enquête comprenaient la consommation actuelle de substances, l'expérience antérieure avec le traitement aux agonistes opioïdes et les opinions liées à la buprénorphine/naloxone. Les facteurs du patient ont été examinés pour déterminer l'association avec l'acceptation de la buprénorphine/naloxone à emporter. RéSULTATS: Sur 89 patients inscrits, l'âge médian était de 33 ans, 27,0% étaient des femmes, 67,4% avaient déjà pris de la buprénorphine/naloxone et 19,1% n'avaient jamais pris de traitement aux agonistes opioïdes. Dans l'ensemble, 78,7% des répondants étaient d'avis que les SU devraient distribuer des paquets de buprénorphine/naloxone à emporter. Trente-huit (42,7%) patients ont accepté la buprénorphine/naloxone à emporter. L'acceptation de la buprénorphine/naloxone à emporter était associée à l'absence de traitement antérieur par agonistes opioïdes, à moins de 10 ans d'utilisation d'opioïdes et à l'absence de consommation de drogues injectables. Les raisons d'accepter comprenaient le fait de commencer un traitement pendant le sevrage; les raisons de rejeter comprenaient une expérience antérieure insatisfaisante de buprénorphine/naloxone et un intérêt pour d'autres traitements. CONCLUSION: Bien que moins de la moitié de notre population à l'étude ait accepté la buprénorphine/naloxone à emporter lorsqu'elle lui était offerte, la plupart ont pensé que cette intervention était bénéfique. Isolément, la buprénorphine/naloxone à emporter à l'urgence ne répondra pas aux besoins de tous les patients atteints de troubles liés à l'utilisation d'opioïdes. Les cliniciens et les décideurs devraient considérer la buprénorphine/naloxone à emporter comme une option à faible barrière pour le traitement des troubles liés à la consommation d'opioïdes par l'urgence lorsqu'elle est intégrée à de solides services de soins de la toxicomanie.

[Inappropriate admissions of Ehpad residents to emergency departments]. / Admissions inappropriées des résidents d'Ehpad aux urgences.

After a review of inappropriate admissions of residents of residential care facilities for the dependent elderly (Ehpad) to the emergency room, we propose ways to reduce them. They include giving the coordinating physician a clinical role, organizing continuity and permanence of care in all Ehpad, signing agreements between Ehpad and hospital for direct hospitalization and collaboration with mobile teams and geriatric hotlines, generalizing the level of medical intervention in Ehpad, and deepening the training of Ehpad caregivers in geriatrics.

[Measuring the emergency psychiatric units activity: An experimental application of the Delphi Method]. / Évaluation de l'activité dans les unités d'urgence psychiatrique : une application de la méthode Delphi.

Psychiatric emergency units (UUP) are nowadays important gateways to healthcare. Whether integrated into general emergency departments or not, these units have very heterogeneous resources and organisations which are not always in line with a populations' needs. The increasing activity of emergency departments in recent years and the recurrent psychiatric bed shortages have shed light upon the weaknesses of this key link in the mental healthcare process. The Seine-Saint-Denis is a department of France located in the Grand Paris metropolis in the Île-de-France region. Ranked third in terms of population size in France, it is marked by social precariousness. With regard to mental health, it has one of the lowest rates of psychiatric beds per capita in France. A great deal of thought has been ongoing for five years on how best to upgrade the offer of unscheduled psychiatric care, particularly the management of emergencies. The growing imbalance between demand and supply depending on living areas urges a rapid equalization of resources. This operation requires an accurate activity characterization, allowing more effective organizations and adequate resource allocation. We sought to characterize the activity of psychiatric emergencies by selecting quantitative and qualitative indicators by means of a consensus method, the Delphi Method, which consists of iterative questioning of an expert group. We first submitted 36 potential criteria to twenty-five experts. Twenty obtained a weak to a strong consensus. Seventeen were then selected as potentially useful for activity characterization. In a second time, we tested the consensus on selected indicators by interviewing a panel of 19 experts. A strong consensus was found on four criteria: "Number of visits for psychiatric advice>2000/year", "Number of emergency room visits>40,000/year", "Density of adult hospital beds<150 per 100,000 inhabitants", "Passage rate for homeless patients and/or outside the sector>10%". Using these criteria in the classification of UUPs would test their validity and provide a potentially helpful tool for improving organizations and resource allocation.

Emergency Department Use for Mental Health Problems by Youth in Child Welfare Services.

Objectives: In Canada, little research has focused on emergency department (ED) use by youth involved with child welfare services, a vulnerable population. Our aims were therefore (1) to examine the characteristics of ED users among child welfare-involved youth, 2) to identify predictors of ED use and 3) to identify youth trajectories to EDs. Methods: Data were collected from child welfare charts from two agencies in Montreal, Canada. Logistic regression was conducted to determine the predictors of ED use. Latent class analysis was used to identify trajectories to the ED. Results: The sample included 226 youth aged 11-18 years. 33% of youth visited the ED at least once for mental health problems during child welfare involvement. ED users were more likely to be youth with a history of 1) sexual abuse, 2) parental mental illness, and 3) placements outside of the home, compared to youth with no ED visits. Mental health treatment was initiated in the 30 days following an ED presentation in 24% of cases. Three trajectories were found: 1) ED contact initiated by child welfare workers for suicidal ideation/attempts, 2) ED contact initiated by police for substance use and externalized behaviours and 3) ED contact initiated by parents for suicidal ideation/attempts. Discussion: Despite all youth being followed by child welfare and many already receiving mental health services, youth had high, often recurrent ED use. This highlights the need for stronger coordination between child welfare, youth mental health services and EDs.

Objectifs: Au Canada, peu de recherche s'est penchée sur l'utilisation du service d'urgence (SU) par les jeunes impliqués dans les services d'aide à l'enfance, une population vulnérable. Nous visions donc à (1) examiner les caractéristiques des utilisateurs de SU chez les jeunes impliqués dans l'aide à l'enfance, 2) identifier les prédicteurs de l'utilisation de SU et 3) identifier les trajectoires des jeunes au SU. Méthodes: Les données ont été recueillies des dossiers de l'aide à l'enfance dans deux agences de Montréal, Canada. La régression logistique a été menée pour déterminer les prédicteurs de l'utilisation du SU. L'analyse de classe latente a servi à identifier les trajectoires au SU. Résultats: L'échantillon comprenait 226 jeunes âgés de 11 à 18 ans, dont 33 % ont visité le SU au moins une fois pour des problèmes de santé mentale durant leur implication à l'aide à l'enfance. Les utilisateurs de SU étaient plus susceptibles d'être jeunes avec des antécédents de 1) abus sexuel, 2) maladie mentale parentale, et 3) placements hors du foyer, comparés aux jeunes sans visite au SU. Un traitement de santé mentale a été initié dans les 30 jours suivant une présentation au SU dans 24 % des cas. Trois trajectoires ont été distinguées: 1) un contact avec un SU initié par les travailleurs de l'aide à l'enfance pour des idéations/tentatives de suicide, 2) un contact avec un SU initié par la police pour utilisation de substances et comportements externalisés et 3) un contact avec un SU initié par les parents pour des idéations/tentatives de suicide. Discussion: Bien que tous les jeunes aient été suivis par l'aide à l'enfance et que nombre d'entre eux aient déjà reçu des services de santé mentale, les jeunes avaient une utilisation élevée souvent récurrente du SU. Ceci met en lumière le besoin d'une coordination plus forte entre l'aide à l'enfance, les services de santé mentale pour les jeunes et les SU.

Management of periorbital cellulitis at the Pediatric Emergency Department: A ten years study.

Periorbital cellulitis is a diagnostic and therapeutic emergency, jeopardizing the prognosis for vision and survival. PURPOSE: The goal of this study was to analyze the epidemiological and therapeutic features and outcomes of periorbital cellulitis cases treated in the pediatric emergency department. PATIENTS AND METHODS: A retrospective study including all the children aged between 1 month and 15 years treated for periorbital cellulitis in the Pediatric Emergency Department of the Mohamed VI University Teaching Hospital in Marrakech over a period of 10 years (January 1, 2010-December 31, 2019). RESULTS: In all, 168 cases of periorbital cellulitis were recorded, with an increasing of the number of cases, from 2 in 2010 to 39 in 2019. The most affected age bracket was the group under 5 years of age (62.5%). The most frequent mode of entry was sinusitis (22%). Preseptal cellulitis was most common (76.7%). The main clinical signs found in orbital cellulitis were proptosis (64%) and chemosis (35.8%), versus conjunctival hyperemia (78%) in preseptal cellulitis. Ophthalmoplegia was present in two cases of orbital cellulitis. The right side was most affected (44%). An orbital CT scan was performed in all cases in our study, showing preseptal cellulitis in 129 patients (76.7%), orbital cellulitis in 14 cases (8.3%), subperiosteal abscess in 20 cases (12%) and orbital abscess in 5 cases (3%). Prior treatment with non-steroidal anti-inflammatory medication was noted in 6%. The most commonly used antibiotic was amoxicillin-clavulanic acid. Steroid treatment was prescribed in 6% of cases. Surgical treatment was indicated in 12 patients (7.1%). The mean hospital length of stay was 3 days for the preseptal cases and 8 days for the orbital cases. All patients had good outcomes with medical and/or surgical treatment. With follow-up of over one year, no complications were noted. CONCLUSION: The majority of our cases had positive outcomes, highlighting the advantage of early diagnosis, adapted antibiotic treatment and multidisciplinary care, rendering surgery rarely necessary.

Occupational Therapy in the Emergency Department: Patient Frailty and Unscheduled Return Visits.

Background. Occupational therapy facilitates care for complex frail emergency department (ED) patients who may have unscheduled return visits (URVs). Purpose. To determine the prevalence of frailty amongst ED patients referred to occupational therapy and if frailty affected the rates and reasons for URVs. Methods. A mixed-methods health records review was conducted of older adults referred to an ED-based occupational therapy program. Findings. Most patients were frail (60.6%). 31.0% of patients discharged home had a URV within 30 days, with no difference in URV rates between frail and non-frail populations. Providing occupational therapy education reduced the frequency of URVs. Frail patients had complex reasons for their URVs, including functional, social/environmental, safety concerns, and/or "failure to thrive". Occupational therapy ED patients were typically vulnerable to moderately frail, dependent in some activities of daily living, and complex. Implications. ED-based occupational therapists must be aware of their patient's frailty and risk of URVs.

[Geriatric pathways and organisation in response to the needs of EDS]. / Organisation et filières gériatriques en réponse aux besoins des SAU.

The emergency department remains the main method of admission for older people to hospital. The management of old elderly in these departments is a complex subject. It's particularities and the specificities of the evaluation of their health contribute to the difficulties of the care teams. For the elderly, a visit to the emergency room is a significant medical event in the care process that can have repercussions on their functional decline. The promotion of a geriatric culture in emergency departments is essential and can be done in different ways, but collaboration between emergency physicians and geriatricians remains essential for successful care adapted to the specific characteristics of elderly patients.

[A pragmatic approach to iatrogenic risk in the emergency room]. / Approche pragmatique du risque iatrogène aux urgences.

The links between the emergency department (ED) and drug-related harm are close. In practice, it is necessary to ask systematically if an iatrogenic accident is possible and to evaluate a new prescription carefully so as not to create iatrogenia during the visit to the emergency department. Any situation in which a nurse takes charge of an emergency room must be subject to precautions. Simple measures should be put in place during any hospitalisation of an elderly person.

[EDS and diagnosis of cardiogenic pulmonary oedema]. / SAU et diagnostic de l'œdème pulmonaire cardiogénique.

Acute cardiogenic pulmonary oedema in the elderly does not differ fundamentally from that seen in the young patient. Appropriate pathways must be established, with regular nursing follow-up, to enable rapid detection and treatment of episodes of acute heart failure. The paramedical team plays an essential role in liaising with families, providing nursing care and listening to the patient at the bedside.

[COVID-19-related respiratory distress in emergency departments: reality and perspectives.] / La détresse respiratoire liée à la Covid-19 aux urgences : réalité et perspectives.

COVID-19 was initially considered exclusively as a respiratory disease. It now appears that it is also a systemic disease with vascular inflammation and thromboses. In the most severe forms, these plurifactorial pulmonary lesions are responsible for acute respiratory distress syndrome. The treatment of this syndrome, which causes hypoxemia, requires urgent oxygen therapy. While initial recommendations favoured the rapid use of intubation and mechanical ventilation, experience seems to confirm that it must be delayed as long as possible, in favour of non-invasive ventilation, less aggressive for the patient.

[Aggression in hospital or home-based care: similar psychological sequelae]. / Agression à l'hôpital ou à domicile : des séquelles psychologiques similaires.

Whether it occurs in emergency departments or in private practice, violence can have a significant and long-term psychological impact on caregivers. Between doubt, fear, guilt and incomprehension, two nurses from the Ile de France share their experience.

Triage in Complex, Coordinated Terrorist Attacks.

INTRODUCTION: Terror attacks have increased in frequency, and tactics utilized have evolved. This creates significant challenges for first responders providing life-saving medical care in their immediate aftermath. The use of coordinated and multi-site attack modalities exacerbates these challenges. The use of triage is not well-validated in mass-casualty settings, and in the setting of intentional mass violence, new and innovative approaches are needed. METHODS: Literature sourced from gray and peer-reviewed sources was used to perform a comparative analysis on the application of triage during the 2011 Oslo/Utoya Island (Norway), 2015 Paris (France), and 2015 San Bernardino (California USA) terrorist attacks. A thematic narrative identifies strengths and weaknesses of current triage systems in the setting of complex, coordinated terrorist attacks (CCTAs). DISCUSSION: Triage systems were either not utilized, not available, or adapted and improvised to the tactical setting. The complexity of working with large numbers of patients, sensory deprived environments, high physiological stress, and dynamic threat profiles created significant barriers to the implementation of triage systems designed around flow charts, physiological variables, and the use of tags. Issues were identified around patient movement and "tactical triage." CONCLUSION: Current triage tools are inadequate for use in insecure environments, such as the response to CCTAs. Further research and validation are required for novel approaches that simplify tactical triage and support its effective application. Simple solutions exist in tactical triage, patient movement, and tag use, and should be considered as part of an overall triage system.

[Nurse coordinator and in-home nursing care services]. / Infirmière coordinatrice et service de soins infirmiers à domicile.

Three nurse coordinators in the Bouches-du-Rhône share their experience and involvement in the in-home nursing care service and the multidisciplinary in-home care and assistance service.

[Evaluation of an "Emergency Thrombosis" care system in a university-hospital department of general emergencies]. / Évaluation de la mise en place d'une filière de soins « Urgence Thrombose ¼ dans un service hospitalo-universitaire d'Urgences générales.

GOAL: Describe the use of diagnostic, prognostic and therapeutic algorithms for venous thromboembolism (VTE), derived from the 2014 European guidelines, in a teaching hospital's emergencies department and compare two groups: the 2015 group "without a care path" and the 2017 group "with a care path". METHOD: Comparative and retrospective study of the characteristics of emergencies department patients admitted for VTE from January to June 2015 for the 2015 group and from January to June 2017 for the 2017 group. RESULTS: Seventy-nine patients were included in the 2015 group and 62 patients in the 2017 group. In 24% of cases a clinical probability rule was calculated in the 2017 group (vs. no score in 2015, P<0.05). In the 2015 group, 10% of patients did not have a D-Dimer measurement in case of low clinical probability (vs. 0% in 2017, P<0.05). For both groups, the severity score sPESI was not noted in the medical record. All patients with pulmonary embolism were hospitalized in both groups. A total of 36% of patients with deep vein thrombosis (DVT) were hospitalized in the 2015 group (vs. none in 2017, P<0.05). A total of 52.5% of patients were treated with direct oral anticoagulants (DOAS) in the 2017 group vs. 32.5% in the 2015 group (P<0.05). In 18% of cases DOAS were prescribed by emergency physicians in the 2017 group vs. 2.5% in the 2015 group (P<0.05). Mean hospital stay was 7.4 days in the 2017 group and 9.4 days in the 2015 group (P<0.05). CONCLUSION: We observed a change in clinical practices and prescriptions after the establishment of an "Emergency Thrombosis" care system. Indeed, improvement in the calculation of the clinical probability score, increase in the outpatient management of DVT, increase in prescribing DOAS and reducing the length of hospital stay were the main revisions. The implementation of standardized digitally calculated clinical and prognostic probability scores would optimize this care path, as well as allow a better distribution of the post-emergency consultations created for outpatients.

[Cranio-encephalic trauma in children at the Emergency room of the Teaching Hospital- Gabriel Touré of Bamako]. / Traumatismes cranio-encephaliques de l'enfant dans le service d'accueil des urgences du Chu-Gabriel Toure de Bamako.

OBJECTIVE: To study the epidemiological, clinical and evolutionary aspects of head trauma in children at the emergency room. METHOD: This was a descriptive longitudinal study over 1 year from February 2016 to February 2017, which included any patient aged 0 to 15 years who had cranial trauma The data were collected from a pre-established questionnaire, analyzed by the software (SPSS 22.0, EXCEL and WORD 2010).The chi-square test or Fisher's exact test was used for the statistical analysis, a value <0.5 considered significant. RESULTS: During the study period, 19825 consultations were performed at the emergency service of which 297 cranial trauma occurred in children, ie 1.5%. The male sex was predominant at 68% with a Sex ratio (H / F) = 2.13. The 6-10 age group was the most represented with 39.4%. The students were the most represented with 58.9%. Road accidents were the predominant mechanism of injury with 54.9%. Civil protection transported 29% of the wounded. The motorcycle-pedestrian mechanism was more frequent at 27.6% (n = 82). CT was severe in 17.8% (n = 53) of patients. The photomotor reflex was abnormal in 29% (n = 86). The trauma of the lower limb was associated in 39.3%. Craniosphalic CT with cervical scan was the most performed with 73.8%. The brain lesions were in the majority with 41.1%. The average care time was 9.82h in 54.2%. Exclusive medical treatment was adopted in 91.2% of cases. The tramadol and paracetamol combination was mainly used in analgesia with 78.1% of cases The evacuation of the hematoma was the most used surgical procedure with 65.4%. Hyperthermia was the most represented ACSOS (secondary cerebral aggression of systemic origin) with 6.7%. Death before care accounted for 5.4% (n = 16), hospital death at 12.8% (n = 38). The admission time to UE was 24-48h in 31.6% (n = 168). Prognostic factors were related to Motor Photo Reflex (p = 0.002), mechanism (p = 0.01), Glasgow score

OBJECTIF: Analyser l'aspect épidémioclinique et évolutif des traumatismes crâniens chez l'enfant au service d'accueil des urgences (SAU). MÉTHODE: Etude longitudinale descriptive sur 1 an qui a inclus tout patient âgé de 0 à 15 ans victime de TCE. Les données ont été recueillies à partir d'un questionnaire préétabli, analysées par les logiciels SPSS 22.0, EXCEL et WORD 2010, les tests (chi-carré, Fisher) ont été utilisés pour l'analyse statistique, une valeur < à 0,05 considérée comme significative. RÉSULTATS: 19825 ont été admis au SAU dont 9912 victimes de traumatismes, parmi lesquelles 297 TCE ont été diagnostiqués chez l'enfant soit 1,5%. Le sexe masculin a été prédominant à 68%. La tranche d'âge 6-10 ans a été la plus représentée 39,4%. Les élèves étaient les plus représentés avec 58,9%. Les accidents de la Voie publique ont été le mécanisme lésionnel le plus fréquent 54,9%.La protection civile a transporté 29% des blessés. Le mécanisme moto-piéton a été plus fréquent à 27,6% (n=82). Le TC était grave chez 17.8% (n=53). Le reflexe photomoteur était anormal chez 29% (n=86). Le traumatisme du membre inferieur était associé dans 39,3%. Le taux de réalisation de la TDM cranioencephalique avec balayage cervical a été de 73,8% et a objectivé des lésions cérébrales dans 41,1%.Le délai d'admission au SAU était 31.6% (n=168) entre 24-48h. Le délai de prise en charge chirurgicale moyenne était de 9,82h chez 54.2%. Le traitement médical exclusif a été adopté dans 91,2% des cas. L'association tramadol et paracétamol a été la plus utilisée en analgésie avec 78,1% des cas. Le geste chirurgical a représenté 8,8% à type d'évacuation de l'hématome avec 65,4%. L'hyperthermie était l'agression cérébrale secondaire d'origine systémique (ACSOS) la plus représentée avec 6,7%. Le décès avant soins a représenté 5.4% (n=16), le décès hospitalier était de 12.8% (n=38). Les facteurs pronostiques étaient le réflexe photo moteur (p=0,002), le mécanisme (p=0,01), le score de Glasgow < à 9 (p=0,003), le délai de prise en charge (p=0,002) et l'association d'au moins deux ACSOS. CONCLUSION: le TCE chez l'enfant demeure un véritable problème de santé publique responsable d'une morbimortalité élevée, la prise en charge des ACSOS en pré hospitalier diminuerait significativement cette morbimortalité.

[Standardized screening of alcohol misuse in emergency wards: The experience of a systematic use of the FACE scale in the European Georges-Pompidou Hospital]. / Repérage standardisé du mésusage de l'alcool au service d'accueil des urgences : l'exemple de la passation systématique du questionnaire FACE à l'hôpital Européen Georges-Pompidou.

INTRODUCTION: By using a standardized and systematic screening with the FACE questionnaire, our aims were : - to determine the prevalence of alcohol misuse (AM) among patients admitted in the emergency department of the European Georges-Pompidou Hospital; - to search for risk factors associated with AM. METHODS: Patients admitted between 9 am and 5 pm were included for 7 consecutive days in June 2017. The variables collected were age, gender, reason for and day of admission, acute alcohol intoxication, benzodiazepines misuse, use of illicit drugs, and the FACE. An AM was defined by a score ≥5 for men and ≥4 for women. Descriptive analyses calculated the prevalence of AM and logistic regressions calculated the risks for AM. RESULTS: A total of 190 men and 221 women were included, with 31% and 19% of them with AM, respectively. The risk of AM was positively associated with male gender, weekend admission and illicit drug use. It was negatively associated with age. The risk of AM was not significantly different according to the reason for admission (trauma versus medical). The risk of AM was not associated with misuse of benzodiazepines. Among the 100 patients with AM, only six had been admitted in acute alcohol intoxication. CONCLUSION: A systematic screening is crucial to identify patients that should benefit from brief intervention or specialized intervention in an addictology unit.

[Epidemiological scope of traditional gold panning with trauma in emergency service at Gabriel Touré teaching hospital]. / Aspects Epidemiocliniques des Traumatismes au Cours de L'Orpaillage Traditionnel au Service D'Accueil des Urgences du CHU Gabriel Toure de Bamako.

INTRODUCTION: Traditional gold washing traumatism during traditional gold panningfalls within the scope of occupational accidents, which are common pathologies in developing countries such as Mali. Our work aimed to study traumatism during traditional gold panning. MATERIAL AND METHOD: A 1-year prospective study from November 2014 to November 2015 on the cases of traumatism during traditional gold washing (TOT) admitted to the emergency room(ER) of the University Hospital Gabriel Touré during the study period. Data were collected from outpatient visit records and medical charts. Data were collected on the survey sheets and analyzed with Epi-info version 7.1.1.0.fr software. Data entry was made with Windows 7 software. RESULTS: During the study period, 21,400 patients were admitted to the ER, of whom 445 patients were victims of traumatism, a frequency of 2.08% of all outpatient visits in the ER. The age group 21-40 years old was the most represented with 64.94% of the cases. The male gender was predominant with 77.08% of the cases with a sex ratio of 3.36. Mine landslides were the most common causality in 65.39% of the cases. Dorsal spine involvement was the most common with 41.80% of cases. Medullary vertebral fracture was the most frequent diagnosis with 43.82% of cases. In total, 79.55% of patients received medical treatment. Patients or were transferred to neurosurgery department in 58.20% of cases. CONCLUSION: Traumatism during traditional gold panning is common. Lesions most often fit in a context of polytraumatism. The rapidity of the diagnosis and management are crucial to the prognosis of the disease.

INTRODUCTION: Les traumatismes d'orpaillage traditionnel entrent dans le cadre des accidents de travail survenu au cours de l'orpaillage traditionnel fréquemment rencontrés dans certains pays en voie de développement comme le Mali. Nous avons entrepris cette étude dans le but d'étudier les traumatismes au cours de l'orpaillage traditionnel. MATÉRIEL ET MÉTHODE: Etude prospective sur un an, de novembre 2014 à novembre 2015 portant sur les cas des traumatismes au cours de l'orpaillage traditionnel (TOT) admis au service d'accueil et des urgences (SAU) pendant la période d'étude. Les données étaient recueillies à partir des registres de consultation, des dossiers médicaux. Les données ont été collectées sur les fiches d'enquête et analysées à partir du logiciel Epi-info version 7.1.1.0.fr. La saisie a été faite à partir du logiciel Windows 7. RÉSULTATS: Durant la période d'étude, 21400 patients ont été admis au SAU, parmi lesquels 445 patients étaient victimes des traumatismes soit une fréquence de 2,08% de l'ensemble des consultations du service. La tranche d'âge de 21­40 ans a été la plus représentée avec 64,94% des cas. Le sexe masculin a été prédominant soit 77,08% des cas avec un sex ratio de 3,36 en faveur des hommes. Les éboulements de mine ont été l'étiologie la plus fréquente avec 65,39% des cas. L'atteinte dorsale était la plus fréquente avec 41,80% des cas. La fracture vertébro médullaire a été le diagnostic le plus fréquent avec 43,82% des cas. La majorité des patients soit 79,55% des cas ont reçu un traitement médical. La plupart des patients soit 58,20% des cas ont été transférés en neurochirurgie. CONCLUSION: Les traumatismes survenus au cours de l'orpaillage traditionnel sont fréquents. Les lésions s'intègrent le plus souvent dans un contexte de poly-traumatisme. La rapidité du diagnostic et de la prise en charge sont déterminants au pronostic de la maladie.

[Involvement of addictovigilance in emergency department for the detection of abuse and dependence cases: 3 years of experience]. / Implication de l'addictovigilance dans un service d'urgence pour la détection et le recueil des cas d'abus et de dépendance : bilan de 3 ans d'expérience.

INTRODUCTION: Due to the increase of hospitalization at emergency department (ED) related to psychoactive substances use (PSU), the addictovigilance center of Montpellier has been integrated into the URGEIM program for the detection of iatrogenic events at the ED. The objective of the present work was to analyze spontaneous reports (SR) collected via the URGEIM program. METHODS: Analysis of spontaneous reports related to PSU at the ED of the Montpellier University Hospital, collected through the URGEIM program, between January 2014 and December 2016. RESULTS: During the study period, 160 SR were collected through the URGEIM program on 1118 SR collected by the Addictovigilance center over the period: 40SR/342 in 2014, 46 SR/303 in 2015 and 74 SR/473 in 2016. Most patients were male (70%) and the mean age at admission was 33 years old. A total of 240 psychoactive substances were identified with 160 illicit substances (66.6%) [cocaine 38.1%, cannabis 30.6%] and 80 medications (33.3%) [buprenorphine 22.5%, benzodiazepines 20% and methadone 18.8%]. Mental and behavioral disorders (20.0%), general health problems associated with substance use (17.5%), cardiovascular diseases (13.1%) and infectious diseases (12.5%) were the main reported effects. The duration of emergency stay was inferior to 12hours in 63.1% of cases and greater than 24hours in 12.5% of cases. In 69.4% of cases, the event was considered as serious. The outcome was unknown for 6.9% of patients. CONCLUSION: The number of SR from ED has increased over the study period, with the notification of serious and worrying cases, and the possibility of setting up actions. The deployment of addictovigilance within clinical services is a significant factor for notification and quality of care.