Marseille, located in the south-eastern part of France, is the second largest city in France, with a population of nearly one million inhabitants. This study was conducted in the PED of a large French public teaching hospital in Marseille (Assistance Publique—Hôpitaux de Marseille) that is responsible for evaluating and treating persons (children, adolescents, and adults) with psychiatric disorders. Care was provided by general psychiatrists. Annual visits to this ED number approximately 3,000. It provides services to 95% of the individuals living in Middletown, Marseille, who present to psychiatric emergencies 15. The ED also guarantees free medical service 24 hours a day, seven days a week, to natives and immigrants, regardless of their legal, social, or economic status. Of note, our hospital has also 2 other emergency departments for paediatric and general cares. If necessary, patients with mental health problems are transferred from these emergency departments to the PED. Finally, a child psychiatrist from local child and adolescent psychiatric services has to be on-call 24 hours a day for the PED.
Data for all episodes of care in the PED from January 1, 2001, to December 31, 2006, delivered on children and adolescents aged less than 18 years were retrospectively analyzed.
2.3. Data Collection
The study involved a retrospective review of administrative and medical databases from the PED. For each episode of care, data on the patient's demographic, clinical, and management characteristics were available. The French National Commission for Data Protection (CNIL) approved this study. Founded on January 6, 1978, the CNIL is an independent administrative authority protecting privacy and personal data [15
]. Because the project involved the retrospective analysis of anonymous administrative data sets—patient names were replaced by a unique identification number—informed consent was not necessary. Principles outlined in the Declaration of Helsinki were followed [16
2.4. Units of Analysis and Definition of Parameters
Because some individuals received multiple episodes of care during the study period, two analysis sets were used: episodes of emergency care and individual patients. If readmission rates varied significantly between patients, the exclusive use of episode data could bias the results.
For emergency care episodes, the following data were examined: reasons for referral, referral source (self-referral, referred by the family, referred by a health care professional, referred by a somatic ED, or referred by a nonhealth care professional), and nature of therapeutic crisis management (consultation or hospitalisation).
For individual patients, demographic and clinical data were collected. Demographic information consisted of age (defined as the mean age during the various contacts) and gender. Clinical information included psychiatric diagnosis. Because patients may present with more than one psychiatric diagnosis in one or several care episodes, we described the diagnostic characteristics only for the individual patients. Diagnoses were established by a senior general psychiatrist based on the ICD-10 sections
]. Dual diagnosis was defined as the co-occurrence of a mental disorder (any) and a substance-related disorder [18
]. Other data regarding the PED analyzed during the study period included the number of emergency care episodes.
2.5. Statistical Analysis
The demographic, clinical, and management characteristics of children and adolescents were described first for care episodes and then for individual patients. Sample characteristics were detailed using means for quantitative variables or frequencies for qualitative variables and their 95% confidence intervals.
The demographic, clinical, and management characteristics were also compared using Student's t-test for continuous variables and chi-squared analysis for categorical variables according to gender, age (</≥16 years), and return to the ED (yes/no). The comparisons were made only for individual patients. All tests were two tailed, and the alpha value was set at P < .05. Data were analyzed using the SPSS, version 18.0, software package.