Clinical Presentations of Adolescents Aged 16–18 Years in the Adult Emergency Department

Abstract

Background: In many large hospitals in Switzerland, adolescents 16 years and older are treated in adult emergency departments (ED). There have been few publications about this specific patient population, especially in Switzerland. This study aims to provide an overview of emergency presentations of adolescents between 16–18 years of age when compared to adults and focuses on their principle complaints. Methods: We conducted a single-centre, retrospective, cross-sectional study of all patients aged 16 years and older presenting to the adult ED at the University Hospital (Inselspital) in Bern, Switzerland, from 2013 to 2017. This analysis gives an overview of emergency presentations of adolescents between 16–18 years of age in this time period and compares their consultation characteristics to those of adult patients. Results: Data of a total of 203,817 patients who presented to our adult ED between 2013 and 2017 were analysed. Adolescents account for 2.5% of all emergency presentations. The number of ED presentations in the reviewed time period rose for adults (+2368, 95% CI: 1695, 3041, p = 0.002 consultations more per year; +25% comparing 2013 with 2017), while adolescent presentations did not significantly increase (p = 0.420). In comparison to adult patients, adolescents presented significantly more often during the night (39.1% vs. 31.5%, p < 0.001), as walk-ins (54.2% vs. 44.9%, p < 0.001), or with less highly acute complaints at triage (21% vs. 31%, p < 0.001). They were more likely to be discharged (70.8% vs. 52.2%, p < 0.001). We found a significant association between the two age groups and principle complaints. In comparison to adults, trauma and psychiatric problems were significantly more common among adolescents. Conclusions: Our data showed that complaints in adolescent patients under 18 years of age significantly differ from those in older patients. The artificial age cut-off therefore puts this vulnerable population at risk of receiving inadequate diagnostic testing and treatment adapted only for adults. Additional studies are needed on the reasons adolescents and young adults seek ED care, as this could lead to improvements in the care processes for this vulnerable population.

Characteristics and management of adolescents attending the ED with fever: a prospective multicentre study

“…A well-known statement emphasises how ‘children are not small adults’;22 23 however, our data show that adolescents are not big children either. Our data show that despite accounting for a small fraction of all ED visits for febrile children, adolescents presenting to the ED have an increased risk of SBIs, such as sepsis/meningitis.…”

“…Previous studies on febrile children have mainly focused on infants and young children 5 and literature regarding febrile adolescents is scarce. A recent study by Brockhus et al 23 on adolescents attending the ED showed that adolescents present with complaints different from those in children as well as adults and that infectious problems were far less common than trauma or mental health issues. However, as stated above, although adolescents present with infectious problems less common than younger children, adolescents that do present to the ED have an increased risk of suffering from a severe infection.…”

“…As adolescents with infectious problems form only a small fraction of ED visits, 23 exposure for each individual healthcare provider is expected to be low, 30 making the management of this group even more challenging. Therefore, there is an urgent need for future studies directed at identifying clinical criteria that can help improve the identification of SBI in the febrile adolescent age group.…”

Presentations to the Emergency Department for Problems Related to Mental Health: Sex Differences in Adolescents

“…To our knowledge, this is the first Swiss study to characterise adolescents aged 16 to 18 years presenting to general adult emergency services due to mental health problems. Overall, one tenth of cases of adolescents presenting to our ED were triaged as having a psychiatric problem [ 1 ]. This shows the importance of understanding mental health conditions among adolescents, especially since these years are crucial in development and maintenance of social and emotional behaviour, which are in turn important for mental well-being [ 4 ].…”

“…Therefore, adolescents aged sixteen to eighteen years are a transitional age group, interposed between paediatric and adult ED services. In a study at our tertiary ED at the Inselspital, we have shown that these adolescents present significantly more often with trauma and psychiatric problems than adults [ 1 ]. The study at hand aimed to gather more detailed information about the adolescents aged 16 to 18 years presenting with psychiatric problems to an adult Swiss ED, in order to characterise this particular group of patients more clearly.…”