Abstract

Alcohol and Drug use in Young People is a current national topic of great curiosity which occasionally, junior doctors manage with less interest during busy A&E shifts and pressing admission beds. A taboo subject infrequently discussed in the Paediatric/Adolescent patient history, health professional competence in assessing risk may also be variable, but could be improved by a strong presence of multi-departmental teaching, publicity of accessible intranet management guidance and on-site service information-specific patient and parent leaflets.

A retrospective analysis of attendance data for 9–17 year-olds to a busy District General Hospital Accident and Emergency Department during a peak festive and school holiday season was conducted. Young persons presenting with potential substance misuse risk factors were identified from diagnosis codes and filtered for specific substance misuse concerns. Highly suspected cases were then audited for management and discharge outcome at point of departure from the department.

A total of 334 young persons between the age of 9–17 years presented to our A&E Department between December 2011-January 2012. Forty (12%) had diagnosis coding for alcohol intoxication, alcohol withdrawal, deliberate drug overdose, head injury, alleged assault, faint, road traffic accident injuries undetermined, psychiatric problem, hyperventilation, collapse and injury to face. Of these, 9 (22.5%) were young persons between 15–17 years-old and identified as high risk for substance misuse. Only 1 case was referred to the Adult medical team, and was admitted, but none of the remaining patients were referred to a Paediatric team and were discharged home or had absconded. Only 1 patient had a documented use of a “Substance Misuse Assessment Tool”, and none had Psychiatric or CAMHS input nor were referred to a Young Person-specific Substance Misuse service.

Health professionals who regularly manage young people in A&E, including A&E nursing staff need essential training in assessing Young People for Substance Misuse. Young Person-specific Substance Misuse clinical guidelines would be useful to increase case management confidence for Paediatricians, junior A&E doctors and Adult Physicians. A valuable resource to the NHS, referral to Young Person-specific services in Substance Misuse should be considered in these guidelines. Multi-departmental, multi-disciplinary agreement is imperative for successful implementation.