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


CONCLUSIONS
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.
Woolfenden
S
S
Centre for the Prevention of Psychological Problems in Children, Children's Hospital at Westmead, Westmead, Australia. susan.woolfenden@swsahs.nsw.gov.au
Dossetor
D
D
Nunn
K
K
Williams
K
K
D000293:Adolescent; D000294:Adolescent Behavior; D017677:Age Distribution; D000374:Aggression / Q000523:psychology*; D002648:Child; D002652:Child Behavior; D015331:Cohort Studies; D016001:Confidence Intervals; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D004638:Emergency Treatment / Q000592:standards / Q000639:trends; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy*; D009517:New South Wales / Q000453:epidemiology; D016017:Odds Ratio; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D017678:Sex Distribution; D015996:Survival Rate; D014505:Urban Population