The increasing prevalence of the agitation states in the emergency department (ED) is a problem little studied on the epidemiological plan.
Objective: To define the prevalence of the agitation states in the ED in France, to determine predicative criteria of the agitation states to prevent a potentially dangerous situation and take care as fast as possible of it, to know current practices in front of these situations, and to collect the recommendations of the departmental managers of the ED to improve this management.
Method: A questionnaire of appraisal was sent to the 464 managers of the ED of hospitals and clinics in metropolitan France, containing 21 questions.
Results: 137 (29.5%) departmental managers answered. The average of admittances by ED is 24,000 a year. The estimated prevalence of the number of situations of agitation represents 1.22% of the total of admittances. The average prevalence a month and by service of verbal attacks is 36.3, that of the physical attacks is 1.14. The number of attacks (and their consequences) correlate with admittances by ED. The intervention of the police is required on average 17 times a year and by ED. Only 29.5% of the ED consider to have premises adapted for the management of the agitated patients; 32.3% of the ED have a protocol established for the agitation states; 16.3% of services accumulate a protocol and a training of the professionals; 10.5% of establishments have at the same moment adapted premises, a protocol and a forming of the staff for the management of the agitated patients. Among the agitated patients, those that profit by a sedation represent on average 67.7% and it varies according to ED. The sedative treatment used in first intention is loxapine in intramuscular injection for 84% of them. The predicative factors identified of agitation states are intoxications, mainly the alcohol (88%) and the poly drug addiction (46.3%). More than half of the ED recommend in a systematic way and for lack of diagnostic orientation the dosages of alcohol, drugs, glycaemia and bloody electrolytes; 85% of the departmental managers consider that a better management of the agitation states rests on the presence of adapted premises and on a specific forming of the nursing staff.
Conclusion: The management of the agitated patients in the ED requires the placing of protocols and of specific trainings as well as of adapted premises. The major prevalence of attacks imposes realization of epidemiological studies and the priority placing of a coherent politics, considering the potential and often real gravity of these behavioural problems.