Revista Adolescência e Saúde

Revista Oficial do Núcleo de Estudos da Saúde do Adolescente / UERJ

NESA Publicação oficial
ISSN: 2177-5281 (Online)

Vol. 14 nº 4 - Oct/Dec - 2017


Páginas 195 a 209

Causes of urgency and emergency care of the adolescente population: integrative review

Causas de las atenciones de urgencia y emergencia del público adolescente: revisión integral

Causas dos atendimentos de urgência e emergência do público adolescente: revisão integrativa

Autores: Itala Keane Rodrigues Dias1; Cícero Magérbio Gomes Torres2; Maria do Socorro Vieira Lopes3; Kelly Fernanda Silva Santana4; Rhavena Maria Gomes Sousa Rocha5

1. Master of Nursing Graduate Program at the Regional University of Cariri (URCA). Crato, CE, Brazil. Nurse of the Federal Institute of Education, Science and Technology of Ceará (IFCE). Tauá, CE, Brazil
2. Doctor in Education from the Federal University of Ceará (UFC). Fortaleza, CE, Brazil. Lecturer at the Department of Biological Sciences of the Regional University of Cariri (URCA). Crato, CE, Brazil
3. Doctor in Nursing from the Federal University of Ceará (UFC). Fortaleza, CE, Brazil. Professor of the Nursing Postgraduate Program at the Regional University of Cariri (URCA). Crato, CE, Brazil
4. Master's Degree in Nursing by the Graduate Program in Nursing at the Regional University of Cariri (URCA). Crato, CE, Brazil
5. Rhavena Maria Gomes Sousa Rocha: Master in Nursing. Lecturer at the Nursing Department of the Regional University of Cariri (URCA). Crato, CE, Brazil

Itala Keane Rodrigues Dias
Instituto Federal do Ceará (IFCE)
Rua Antônio Teixeira Benevides, 01, Planalto dos Colibris
Tauá, CE, Brasil. CEP: 63660-000

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How to cite this article

Keywords: Adolescent health, adolescent, emergencies, hospitals.
Palabra Clave: Salud del adolescente, adolescente, emergencias, hospitales.
Descritores: Saúde do adolescente, adolescente, emergências, hospitais.

OBJECTIVE: Identify the causes of hospital care for adolescents in urgency and emergency services between the years 2005 and 2014.
DATA SOURCES: The integrative review was conducted in 2014, using as data sources the Capes / MEC Portal of Periodicals, LILACS (Latin American and Caribbean Literature in Health Sciences), MEDLINE (Medical Literature Analysis and Retrieval System Online) and BDENF (Nursing Database), using the Health Science Descriptors "adolescent" and "emergencies" with the boolean operated AND. We tried to answer the following guiding question: What are the causes of the hospital attendance of the adolescent public in the urgency and emergency sector? The inclusion criteria that guided the search were: complete studies available; written in English, Spanish or Portuguese; format of the document in article, thesis or dissertation; published between the years 2005 and 2014; study participants composed of 50% or more of adolescents; and contain in the results the answer to the guiding question. The exclusion criterion were studies that were not consistent with the objective of the integrative review.
DATA SYNTHESIS: 18 studies were found, which identified external causes as the main reasons for attending adolescents related to traffic accidents, violence, suicide attempt and injuries during leisure and sports practices.
CONCLUSION: The main causes of care are due to avoidable causes, which can be combated with socio-educational public policy measures, focusing on health promotion practices and disease prevention.

OBJETIVO: Identificar las causas de la atención hospitalaria de los adolescentes en los servicios de urgencia y emergencia entre los años 2005 a 2014.
FUENTE DE DATOS: La revisión integral fue realizada en 2014, utilizando como fuente de datos el Portal del Periódico de la Capes/MEC, LILACS (Literatura Latino-Americana y del Caribe en Ciencias de la Salud), MEDLINE (Medical Literature Analysis and Retrieval System Online) y BDENF (Base de Datos en Enfermería), empleando los Descriptivos en Ciencia de la Salud "adolescent" y "emergencies" con el operado booleano AND. Se buscó responder a la siguiente pregunta dirigida: ¿Cuáles son las causas de las atenciones hospitalarias del público adolescente en el sector de urgencia y emergencia? Los criterios de inclusión que dirigieron la búsqueda fueron: estudios completos disponibles; escritos en idioma inglés, español o portugués; formato del documento en artículo, tesis o disertación; publicados entre los años 2005 a 2014; los participantes de los estudios ser compuestos de 50% o más de adolescentes; y contener en los resultados respuesta a la pregunta dirigida. El criterio de exclusión fue estudios no condecentes con el objetivo de la revisión integral.
SÍNTESIS DE DATOS: Fueron encontrados 18 estudios, los cuales apuntaron como principales motivos de atención a los adolescentes las causas externas relacionadas a accidentes de tránsito, violencia, intento de suicidio y lesiones durante el descanso y prácticas deportivas.
CONCLUSÍON: Las principales causas de atención son por causas evitables, las cuales pueden ser combatidas con medidas de políticas públicas socioeducativas, con enfoque en las prácticas de promoción a la salud y prevención de agravantes.

OBJETIVO: Identificar as causas do atendimento hospitalar dos adolescentes nos serviços de urgência e emergência entre os anos de 2005 a 2014.
FONTES DE DADOS: A revisão integrativa foi realizada em 2014, utilizando como fontes de dados o Portal de Periódico da Capes/MEC, LILACS (Literatura Latino-Americana e do Caribe em Ciências da Saúde), MEDLINE (Medical Literature Analysis and Retrieval System Online) e BDENF (Base de Dados em Enfermagem), empregando os Descritores em Ciência da Saúde "adolescent" e "emergencies" com o operado booleano AND. Buscou-se responder à seguinte pergunta norteadora: Quais as causas dos atendimentos hospitalares do público adolescente no setor de urgência e emergência? Os critérios de inclusão que nortearam a busca foram: estudos completos disponíveis; escritos em idioma inglês, espanhol ou português; formato do documento em artigo, tese ou dissertação; publicados entre os anos de 2005 a 2014; os participantes dos estudos serem compostos de 50% ou mais de adolescentes; e conter nos resultados resposta à pergunta norteadora. O critério de exclusão foi estudos não condizentes com o objetivo da revisão integrativa.
SÍNTESE DOS DADOS: Foram encontrados 18 estudos, os quais apontaram como principais motivos de atendimentos aos adolescentes as causas externas relacionadas a acidentes de trânsito, violência, tentativa de suicídio e lesões durante lazer e práticas esportivas.
CONCLUSÃO: As principais causas de atendimentos são por causas evitáveis, as quais podem se combatidas com medidas de políticas públicas socioeducativas, com enfoque nas práticas de promoção à saúde e prevenção de agravos.


Adolescence is one of the stages of life in which there is a diversity of risks and vulnerabilities that can interfere with the health condition of adolescents, because it is at this moment in life that rapid and intense changes are experienced in the biological, physiological and emotional fields1. In this way, the expectations related to the changes of the body, gender identity, reproductive capacity, love relationships, professional choice, financial independence, emotional maturity, among others, constitute situations of conflicts arising from commonly experienced anxieties2.

Therefore, all these conflicts pose risks to the health of adolescents because they may experience, incessantly, new sensations, experiences, hitherto unknown environments. These experiences expose them to a variety of vulnerabilities, such as the use of drugs, the initiation of unprotected early sexual intercourse, frequent unsafe environments, which may have as outcomes: accidents, violence, unwanted pregnancies, Sexually Transmitted Infections ), mental disorders, among others3.

As a result, the inherent weaknesses in this stage of life result in high demands on health services, with a greater emphasis on emergency and emergency services, due to definitive injuries and disabilities, causing physical, emotional and social damages, as well as intense suffering for households and expenditures for public health1.

These damages are therefore a great loss to society, since young people represent the highest hopes of every nation and, at the same time, bring to light the vulnerabilities and contradictions of each society. However, for the most part, the needs of this public are not taken into account by public policies and decision-making. Therefore, it is indispensable that they live in a society that asserts their rights as citizens, in a context that ensures health, citizenship, social participation, education, leisure and culture4.

In order to meet the specificities of adolescence, taking into account the particularities of this age group to guarantee universal, hierarchical and regionalized access, within the precepts of the Unified Health System (SUS), it is necessary to know the vulnerabilities and health problems that affect this public 5 . Based on this, the present study was based on the following guiding question: "What are the causes of hospital visits of the adolescent public in the emergency and emergency sector?". In order to answer this question, the articles of the scientific literature will be analyzed between the years 2005 and 2014, which will contribute with an instrument that will provide support and direct the management and planning of effective programs and policies for adolescents, focusing on preventive measures, control and reduction of the main causes that lead adolescents to use health services for preventable causes.


In order to reach the objective proposed by the study, an integrative literature review was carried out, which consists of a research method that allows the search, critical evaluation and synthesis of the available evidence of the investigated subject, with its final product being the state current knowledge of the topic investigated6. Thus, six steps were suggested by Mendes, Silveira and Galvão: 1) Identification of the research question; 2) Search in literature; 3) Categorization of studies; 4) Evaluation of studies included in the review; 5) Interpretation of results; 6) Presentation of the review6.

The review in the literature followed the following guiding question: What causes the hospital visits of the adolescent public in the emergency and emergency sector? The selection of articles was carried out by means of an online search of the scientific productions on the proposed theme, present in the databases: Latin American and Caribbean Literature in Health Sciences (LILACS), CAPES / MEC Journal Portal, Medical Literature Analysis and Retrieval System Online (MEDLINE) and Nursing Database (BDENF). For the search the cross-search of the teenage Science Science Descriptors (DeCS) of the keywords in Portuguese "adolescent" and "emergencies" was performed using the Boolean operator "AND".

For the selection of the studies, some inclusion and exclusion criteria were established. At the outset, during the search in all data sources the filters were used: complete studies available; written in English, Spanish or Portuguese; format of the document in article, thesis or dissertation; publications between the years 2005 to 2014. After the above mentioned filters, the studies were selected through the reading of their titles, searching for those that had an approximation with the researched topic. At the end, only those who answered the guiding question of the integrative review were included, where it was established that the adolescents should correspond to 50% or more of the participants of each study analyzed. It was used asexclusion criterion studies not consistent with the objective of the integrative review.


In the data sources used were found 1,150 studies, which passed through full text filters and available, leaving 1,086 studies written in English, Spanish and Portuguese. After the document type filter (thesis, article and dissertation), 1,063 remained, of which only 715 were published between the years 2005-2014. After reading the title, it was possible to identify those that had an approximation to the search objective, obtaining a number of 81 articles. A further study of the 81 studies was started, again applying the exclusion criteria, resulting in a final sample of 18 studies, 12 of which were found in MEDLINE, three in the Portal of Periodicals of CAPES, two in LILACS, and one in BDENF. Figure 1 presents the quantitative studies found in the respective data sources used in the integrative review, according to the filters used.

Figure 1. Total studies found in the respective data sources, according to the filters used.

In order to better understand the profile of the studies included in this review, in compliance with the inclusion and exclusion criteria, Table 1 presents methodological characteristics adopted by the respective authors, as well as the format and language of the studies.

The studies analyzed used predominantly the documentary research on patient records, computerized systems and patient records. In this way, the instrument used for data collection was the form. All the studies used a quantitative approach, where eight studies stood out having a transverse and retrospective character, respectively. Aside from one study, all are full articles published in journals. The Portuguese language excelled (eight), followed by English (seven) and Spanish (three).

Table 2 also presents methodological characteristics of the respective studies included in the research with emphasis on the place where the studies were conducted, the corresponding period of data collection, followed by the age and proportion of adolescents who participated in the studies.

Studies were conducted in different countries: Brazil, Jamaica, Mexico, Spain, the United States and France. Half of them were developed in Brazil (nine), carried out in different Brazilian states, covering capitals. The studies presented a heterogeneous distribution referring to the corresponding years of data analysis. Regarding the age of the population, seven of them were only with adolescents.

Table 3 describes the overall objective of the studies, followed by the profiles of the participants and the causes of urgency and emergency care of the respective studies included in the research.

According to the findings, the external causes were related to traffic accidents, falls, aggressions, cerol lines, firearms and fireworks. These causes have resulted in fractures, sprains, cuts, lacerations, bruises, dislocations, burns, wounds and suffocation occurring predominantly in the upper and lower limbs in males. Brown and black people had higher prevalence and accidents on public roads and at home were the most frequent places. The months of greater attendance caused by fireworks and cerol lines were January, June, July and December.

Of those who indicated the suicide attempt, the main forms were intoxication, poisoning and violent methods. These two first ones were predominantly used by the girls, whereas the boys had more tendencies for the last one. The prevalence of females was unanimous in studies that raised suicide, related mainly to family conflicts.

Sports injuries were also highlighted, even those that did not only address sports injuries, pointed out in their results games and sports activities as the main causes of care. Of the sports practices, the one that gained prominence in all was the soccer. Male appointments were more frequent, lower limbs, head and neck were the sites of the body most affected, and the most common injuries were bruises, fractures, abrasions and sprains.

Four other articles that studied, in a general way, the causes of care in the sector highlighted the same causes found in other studies, adding diseases in the respiratory system and infectious and parasitic diseases. Other demands such as external causes such as attempted suicide, injuries and trauma were also noted. The male audience in these studies also excelled with the exception of Dubuc and Ferrari (2006), where girls were predominant.

Of all the studies analyzed, only one addressed acute alcohol intoxication in adolescents, where girls were the most affected.


The researchers chose predominantly for documentary research as a method capable of obtaining a variety of information from both the present and the past, in a practical, fast and precise way24. The choice of this type of research is justified by the design of the studies, most cross-sectional and retrospective, studies with high descriptive potential, analytical simplicity, speed, objectivity in data collection and ease of obtaining a representative sample of the population24.

The articles used various types of documents, from information sheets, diskettes, to computerized systems. As a result, there is an increasing tendency to improve and innovate computerized systems that can organize the data of the health services in order to facilitate the recording and analysis of the data. These records represent important sources of data that contain a diversity of information that can support the development of research, planning and situational diagnosis to guide public policies.

The population chosen for the studies was a finding that drew much attention. Only seven studied exclusively the adolescent public, which reveals that there is still a great gap regarding studies with this public. Regarding the causes of care found in the research, the external causes are essentially the causes of care in the emergency and emergency services of adolescents. In the rich countries of the Americas, these are responsible for 53% of the total overhead of the top 10 diseases between five and fourteen years of age. In developing countries, external causes account for 98% of deaths among children and young people 25 . Risk factors include poverty, single and young mothers, low maternal education, poor housing conditions, large families, and use of alcohol and drugs by parents. In Brazil, external causes are the third cause of death and in some regions become the second, however, for adolescents are the first cause of death26.

Among the reasons for attendance due to external causes of the studies, traffic accidents were highly representative. These findings may be associated to the progressive increase in the circulation of vehicles, especially motorcycles;improper pathway condition; lack of vehicle maintenance; recklessness of drivers; ingestion of alcohol and other drugs while driving; disrespect of traffic laws; low adherence to the use of safety equipment; among others. Traffic accidents on the part of adolescents may be related to the lack of attention when circulating in streets, avenues and highways; not respecting the pedestrian range and not crossing on footbridges; neglect of family members, who often allow young people to drive without proper qualification3.

In this way, the findings of this study reaffirm the vulnerability of adolescents to trampling and other traffic accidents. Therefore, it is imperative to establish effective strategies for policing and education in traffic, as well as creating safe spaces for the recreation of children as alternatives to address this vulnerability11.

Of the reasons for attendance due to external causes, violence was another circumstance quite prevalent in the studies analyzed. This finding reveals that criminalization and its banalization are becoming increasingly consolidated in urban centers. Injuries by firearms may be associated with conflicts among peers, thefts and robberies, and teenagers both victims, as co-authors15.

Physical violence and aggression to adolescents tend to be more frequent depending on the urban context they reside. Aspects such as class inequalities, exposure to fights, illegal arms possession, gang disputes and exposure to violent acts practiced by strangers, the consumption of alcohol and other drugs on public roads, schools, are some factors that potentiate fatalities1.

Other external causes noted in the studies were injuries from fireworks and cerol lines. These findings allow us to rethink the practice using fireworks and wax lines taken as fun for many, when taken in inappropriate places and those who do not have skills, they can result in major repercussions for the health of adolescents12,15. An important finding was the time of year that these two events were common: January, June, July and December. In these months occur holidays and festive dates like Christmas, New Year's Eve and St. John, for example, providing opportunities for the increase in these practices, making them more susceptible to being affected by burns and other injuries12,15.

The predominance of males in the external causes is attributed to cultural issues that encourage boys to carry out activities with the greatest potential for exposure, give them greater freedom and, consequently, cause greater exposure to risk situations1.

Suicide attempts had a very large representation in this research. This data is therefore a warning to health care professionals and services, indicating the importance of dialogue making room for young people to express their feelings and anxieties. The fact that girls excel in meeting these causes can be explained by this kind ability to address common adolescent conflicts, like the changes in the body, acceptance of their peers and disruption of loving relationships7,8,9,10. The most common reasons for attempted suicide are interpersonal conflicts among young people. Adolescents are particularly prone to develop suicidal ideation by egocentric thinking style of this phase of life. To this is added the fact that teenagers have few life experiences and limited problem solving skills, making suicide may seem the best option to get out of a difficult interpersonal relationships10.

The occurrence of injuries, especially during sports activities, is another very common reason of urgent and emergency care, and can be the result of high participation of adolescents in sports practices. During school life, they are encouraged to actively participate in competitions activity in school games and tournaments. It is known that the discipline of sports activities is included as mandatory in many educational institutions. Young people see these activities as a time of leisure and recreation and that depending on the sport's dynamics, skills and physical condition of each, can result in injuries, mainly sprains, dislocations, bruises and fractures18,19,20.

Of the studies that have brought diverse causes of care, respiratory diseases and infectious and parasitic diseases were calls of motifs found only two studies9,17. This may be related to the social and economic as well as the period in which these studies were developed. Infectious and parasitic diseases reflect the conditions of basic sanitation, housing, food, environment and lifestyle where teenagers are inserted, which become factors that can favor the spread and prevalence of these diseases. Respiratory diseases in this age group are often related to the occurrence of chronic diseases, to learn that the technical and scientific improvements have provided greater survival of children and adolescents affected by these diseases. For Campaign, Freire and supplies (2008), the symptoms of these diseases directly affect the physical well-being, emotional and social teenager, impair sleep resulting in fatigue and daytime sleepiness, contributing to reduction in learning and reduced quality of life, reflecting decreased exercise tolerance and increased school absences27.

The study that brought acute alcohol intoxication reveals that teenagers have used frequently and harmful form of alcoholic beverages, and even of other drugs. Although the sale of alcohol to minors is prohibited, the lack of effective supervision and violation of the law makes teenagers obtain these substances easily, which can cause irreparable damage to their lives when consumed in excess14.


It could be concluded that the hospital care causes the teenage audience at the emergency room and emergency were predominantly external causes related to traffic accidents, violence, suicide attempts and injuries during leisure and sports. Therefore, this study evidence that the main reasons for consultations are due to preventable causes, which can be tackled with educational measures and the promotion practices focus on health prevention diseases.

The results of this study confirm the need to strengthen public policies directed at adolescents, in order to reduce the number of morbidities that affect young people and hence reduce the number of services in this sector, reducing spending for public health as well as providing a better quality of life for adolescents.

Therefore, the quality of health services to meet the specific needs of adolescents need to be improved and qualified with professionals able to understand the importance of the various dimensions that permeate the lives of young people, overcoming various obstacles. The first of these is to recognize the urgency and importance of investing in adolescence so that we can achieve the Millennium Development Goals with equity.

To ensure that those policies are implemented effectively, it is necessary to take into account the social, economic and cultural context in which young people are placed, taking into account the particularizas of each region as well as engaging in coordination of all civil society.

The research was limited to the small number of included studies, due to the unavailability of some sources and have been conducted in only a few databases.


In the integrated Faculty ducks and Regional University Cariri, by providing constant training and qualification.


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