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Facteurs de risque, dépistage et prévention des syndromes post-traumatiques à la suite d'un passage aux urgences

Abstract : Worldwide, tens of millions of people suffer minor injuries and many are admitted to emergency departments (ED). This represents approximately 5 million ED admissions in France and nearly 40 million in Europe each year. For several years, studies have suggested that up to 20% of these patients will suffer for months from chronic symptoms initially described in mild traumatic brain injury (MTBI) and referred to as "post-concussion syndrome" (PCS). Today, these symptoms have been identified as non-specific to TCL and most authors use the term "Post-Concussion-Like Symptoms" (PCLS). Such a combination of symptoms can lead to a significant deterioration in the quality of social and family life or delay the return to work or school. In France, if the results described in the literature are representative of the entire population, up to one million people could be affected by this currently poorly identified public health problem.The different objectives of this work were as follows:- to identify the factors associated with the development of "Post-Concussion like symptoms" at a distance from an emergency room visit,- to develop a tool to assess the level of risk of developing these symptoms for patients managed in emergency departments- to identify interventions that could be offered to emergencies as a means of prevention.- to assess the value of implementing interventions in the ED to prevent these symptoms from occurring.We found in SOFTER 1 that PCLS were associated with stress at the ED discharge. Then, after creating a risk assessment tool, we showed that it is possible to conduct EMDR sessions during ED stay. The effectiveness of this intervention appeared to be influenced by many factors such as patients' socio-economic conditions, stress level and psychologists' experience.Thus, results currently available suggested that ED could be a place to identify and manage fragile patients at risk of developing PCLS. The opportunity offered by ED visit could have a significant impact in terms of public health and could be a powerful community health tool to combat health inequalities.
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Submitted on : Tuesday, June 2, 2020 - 1:08:03 AM
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Cédric Gil-Jardiné. Facteurs de risque, dépistage et prévention des syndromes post-traumatiques à la suite d'un passage aux urgences. Médecine humaine et pathologie. Université de Bordeaux, 2019. Français. ⟨NNT : 2019BORD0211⟩. ⟨tel-02724754⟩

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