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Alcohol, violence and substance related presentations to A&E in 16-18 year olds: the need for targeted adolescent services
  1. K Wright1,4,
  2. K Oyeyinka2,4,
  3. I Gilmour3,
  4. R Salter3,
  5. I Maconochie3
  1. 1Foundation Year 1, The Royal Berkshire Hospital, Reading, UK
  2. 2Foundation Year 1, Hammersmith Hospital, Imperial College NHS Trust, London, UK
  3. 3Paediatric Emergency Medicine, St Mary's Hospital, Imperial College NHS Trust, London, UK
  4. 4School of Medicine, Imperial College, London, UK


Hazardous and harmful drinking patterns are increasing in adolescents. Heavy adolescent drinkers are more likely to continue as hazardous drinkers. Furthermore, alcohol and substance misuse in young adults is linked to violence and mental health problems later in life, meaning these problems should be managed as early as possible. This audit's aim was to ascertain the influence of alcohol, substance abuse and violence, on presentations to A&E, of 16-18 year-olds over one year.

Method Symphony computer tracking system was used. Presentations of patients aged 16 to 18 years from 1 March 2010 to 1 March 2011 were studied. Their presenting complaints were recorded; non-specific presenting complaints were explored individually for misuse of alcohol, substance abuse and/or violence.

Results There were 2192 presentations. ‘Apparently drunk’ and ‘assault’ featured in the top 20 presenting complaints; 9.1% of all presentations involved violence and 4% involved alcohol (figure 1).

These presenting complaints are only the tip of the iceberg (figure 2).

Many triaged cases did not specify whether alcohol, violence or substance abuse were involved. Cases may be missed by not being flagged up at the triage stage.

Impact Subsequently, a multidisciplinary group including nurses and doctors from paediatric and adult A&E have established guidelines for referral and produced an adolescent related proforma to ask about sexual health, mental health, alcohol and substance misuse. As the hospital became a Major Trauma Centre in January 2011, the number of cause for concern forms increased by a factor of 8, many being patients in the 16-18 year age bracket. This meant a steep learning curve for adult A&E doctors and nurses.

Children, adolescents, vulnerable young people are discussed at the weekly interdepartmental meeting (includes CAMHS team, substance misuse and alcohol worker, and liaison social workers). Alcohol and substance misuse information and advice leaflets, geared to adolescents, are available in the Emergency Department.

Having set these standards, this work will be repeated in one year to see if there has been an improvement in the quality of care delivered to this vulnerable group.

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