The presentation of aggressive children and adolescents to emergency departments in Western Sydney

Authors

  • S Woolfenden,

    1. Centre for the Prevention of Psychological Problems in Children,
    2. Department of Paediatrics and Child Health, University of Sydney, Sydney, New South Wales, Australia
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  • D Dossetor,

    1. Division of Psychological, Developmental and Rehabilitation Medicine,
    2. Department of Paediatrics and Child Health, University of Sydney, Sydney, New South Wales, Australia
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  • K Nunn,

    1. Child and Adolescent Mental Health Services Network,
    2. Department of Paediatrics and Child Health, University of Sydney, Sydney, New South Wales, Australia
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  • K Williams

    1. Clinical Epidemiology Unit, Children's Hospital at Westmead, Westmead and
    2. Department of Paediatrics and Child Health, University of Sydney, Sydney, New South Wales, Australia
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Dr Sue Woolfenden, Ambulatory/Community Paediatrics, B wing, Liverpool Hospital, PO Box 3084, Liverpool, NSW 2170, Australia. Fax: +61 2 9828 6798; email: susan.woolfenden@swsahs.nsw.gov.au

Abstract

Aim:  To examine the utilization characteristics of children and adolescents with aggression presenting to emergency departments (ED) in Western Sydney.

Methods:  Retrospective chart review of children and adolescents who presented with aggression to five non-psychiatric emergency departments over a 5-year period. Data were linked with the National Coroner's Information System Database.

Results:  There were 279 index presentations by children and adolescents (66% male) with aggression. One hundred and seventeen (42%) were 14 years or under. The majority presented after working hours and/or on weekends (62%). Fifty-three percent of presentations had a self-harm component. In 26% of presentations, there was no documentation of mental health involvement. Children were discharged in 62% of presentations. Sixty-eight (24%) children and adolescents subsequently re-presented on 135 occasions with self-harm and/or aggression over the 5-year period. Four (1%) adolescents died.

Conclusion:  A presentation to an ED with aggression by a child or adolescent is an indicator of significant psychosocial dysfunction. These children and adolescents present when services are least accessible and are at risk of re-presentation and death. To address this issue, systems need to be developed that facilitate collaboration between EDs and child and adolescent mental health services.

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