B. Thélot

SFP CO-54 - La surveillance épidémiologique des défenestrations accidentelles d’enfants : enquêtes 2005, 2006 et 2013

Objectifs Les enquetes Defenestrations ont pour objectifs de decrire le nombre, les circonstances, la gravite et l’evolution des chutes accidentelles de grande hauteur d’enfants. Sujet/materiels et methodes Apres une premiere enquete en 2005, deux enquetes ont ete menees du 15 mars au 15 octobre 2006 et 2013 dans 3 regions (IdF, NPdC, PACA), sur toutes les chutes accidentelles de 3 metres ou plus, d’enfants de moins de 15 ans. Resultats principaux Pendant les 7 mois de l’enquete 2013, 76 chutes ont ete recensees (taux d’incidence 1,9/100 000). Il s’agissait surtout d’enfants de moins de 6 ans (62 %), majoritairement des garcons (70 %). Dans 82 % des chutes un adulte etait present, un meuble se trouvait sous l’ouvrant dans la moitie des cas. Neuf enfants sont decedes (12 %), 8 ont garde des sequelles. La comparaison des 3 enquetes montre peu de difference de caracteristiques des accidents. Cependant le nombre de cas a diminue en Ile-de-France (64 en 2006, 51 en 2013). Conclusions Les caracteristiques de ces accidents sont confirmees par la litterature internationale. Les actions de prevention initiees en 2006 en France doivent etre poursuivies : recommandation de surveillance des enfants par les adultes, pas de meuble sous les ouvrants, systemes d’ouverture de fenetre adaptes.

Descriptive study of dog bites in France—Severity factors, factors of onset of sequelae, and circumstances. Results of a survey conducted by InVS and Zoopsy in 2009-2010

ABSTRACT An interdisciplinary epidemiologic survey was undertaken on dog bites in France from May 1, 2009 to June 30, 2010. Medical information was collected from 8 emergency services, and a telephone questionnaire was conducted by veterinary behaviorists. A second questionnaire was conducted 1 month after the dog bite to determine how the bite wound had healed. In children, dog bites were more frequent on the head and neck, but the lesions were more severe in adults. Bites were more numerous and more severe when the victim knew the dog that bit them. No association was found between the severity of the bite and the type of dog that bit, including breed, sex, and weight. In adults, bites occurred primarily as a result of the victim trying to separate 2 fighting dogs, whereas children were bitten when they interacted with a familiar dog. Among those who responded to the follow‐up questionnaire 1 month after the bite, 39% reported sequelae. Esthetic sequelae were the most (80%) of sequelae reported. Women and adults reported more sequelae than did men and children. Measures should be adopted based on the results of this survey.

483 Dog bites: severity and sequelae, a multicenter survey, France, September 2010 – December 2011

Background Every year in France, dog bites result in several thousand admissions in emergency departments and numerous hospitalizations. The purpose of this survey was to identify severity factors and sequelae due to dog bites. Methods An epidemiological study about the severity of 485 dog bites was carried out in eight hospital emergency departments between 2009 and 2010; a study investigating sequelae 16 months after the bite was conducted among 298 of the 485 patients. Patients and dogs characteristics were collected by caregivers and veterinarians, 16-month sequelae were asked to patients by questionnaire. Multivariate regression analyses were conducted to explore severity and sequelae risk factors. Results In children, bites were more frequent in the head and neck, but lesions were more severe in adults. The bites were more numerous and more serious when the victim knew the biting dog. No association was found between the severity of the bite and the type of biting dog. Almost half of respondents (47%) reported sequelae; most of them were aesthetic (91%). There were more sequelae when the bite was located at the head or inferior limbs; the sequelae were more frequent among women, when the weight of the biting dog was higher, and when the initial severity of the bite was higher. The link between the victim and the dog, the sex of the dog, the type of aggression, as well as the age of the victim, had no impact on the occurrence of sequelae. One patient out of seven was still having pain 16 months after the bite, women more often than men. Conclusions Numerous patients still suffer 16 months after a dog bite, articles providing this type of results were not found in the literature. Dissemination of these results among professionals (physicians and veterinarians) and the general public should contribute to make dog owners aware of the risk of bite and the means to avoid them.

Ability to swim among 15–75 years in mainland France and overseas departments: Results of the national survey “Baromètre Santé”

Introduction In France, drownings are responsible for about 500 accidental deaths every summer. The majority takes place during bathing, making the ability to swim a key element of drowning prevention. Little is known about the ability to swim in French population, the purpose of this work is to provide estimations and to study the factors on this topic. Methods Respondents of the Barometre sante 2010, 2014 [in overseas departments (OD): Guadeloupe and Martinique Islands in Caribbean, Reunion Island in Indian Ocean and French Guyana and Northeast Coast of Brazil] and 2016, were interviewed on their ability to swim. The proportion of people knowing how to swim is expressed in weighted percentages (standardized cross-structure sex, age), completed with 95% confidence intervals. The sociodemographic, economic, and health factors associated with the ability to swim have been studied by logistic regression models. Results In 2010, 81.3% of respondents reported being able to swim (12.8% about 10 meters, 68.5% 50 meters or more). In 2016, they were 83.7% (14.7% about 10 meters, 69.0% 50 meters or more). The OD inhabitants declared being able to swim: 72.2% in Martinique, 69.3% in Guadeloupe, 68.6% in French Guiana, 75.0% in Reunion. Men were more able to swim than women overall (87.8% versus 75.2% in 2010 and 89.2% vs. 78.3% in 2016 in mainland France), and at all ages. Young respondents were more often able to swim than their elders (in 2016, 94.8% among 15–24 years versus 64.7% among 65–75 years in mainland France). Other factors were significantly associated with ability to swim: high-school level, higher socio-professional category, good financial situation, not living alone, normal weight, good mental health and French regions. Conclusions This work shows that more than one French out of seven do not know how to swim. The younger the people are, the higher is the proportion of people knowing how to swim. Those results are very rare in international literature. Learn to swim program launched in 60s, particularly in the school environment, is most likely responsible for considerable improvement of the ability to swim of the population, particularly among women. However, still a lot of French older than 55 years cannot swim, and it is precisely this age group, which is particularly affected by drowning. It is important to remember that the learning of swimming can be done at any age to prevent the occurrence of drowning.

Causes of burn based on hospitals reports in mainland France in 2014

Introduction Burns are defined as an injury to the skin or other organic tissue primarily caused by thermal or other acute trauma. Every year in France, burns are responsible for several hundreds of deaths and about 11,500 hospitalizations. Furthermore, burns often result in heavy physical, psychological or social sequelae. They are one of the most expensive traumatic injuries due to costly wound treatment and very long care (hospitalization and rehabilitation). Prevention of burns is therefore a necessity. In order to prevent burns, knowledge about their causes is essential. There is a lack of large-scale results about causes of burns in France. Therefore, the aim of this work it to analyze causes of burns in mainland France in 2014, using data from the hospital nationwide database - “Programme de medicalisation des systemes d’information (PMSI)”. Coding of causes is expected to present high-quality because three French agencies “Agence technique de l’information sur l’hospitalisation” - (ATIH), “Societe francaise de brulologie” (SFB) [formerly “Societe francaise d’etude et de traitement des brulures” (SFETB)] and “Sante publique France” [formerly “Institut de veille sanitaire” (InVS)] implemented in 2011 a thesaurus of burns causes in order to facilitate and harmonize the coding in the PMSI and make it mandatory in 2013. Methods Analyses were performed on first hospital stays in a burn center, in 2014 in mainland France, registered in the PMSI database with a principal diagnosis of burns, coded from T20 to T32 in the International Classification of Diseases, 10th revision (ICD10), and at least one associated diagnosis mentioning a cause of burn. Data collected for patients whatever the age included: demographics, circumstances (accident, assault, suicide attempt), etiology (scald, contact, fire and flames, radiation, electrical, chemical). Results In 2014 in mainland France, 2712 patients were hospitalized in a burn center and presented information regarding the cause of burn, 61.5% were men, mean/median age of 31/28 years. Burns occurred mostly in accidental circumstances (93.7% of patients) and are more rarely due to suicide attempt (4.9%) or assault (1.4%). Half of accidental burns were scald (50.8%), 27.2% fire and flame burns, 8% contact burns, 4.5% chemical burns, other etiologies are scarcer. Causes of burns varied according to age and sex. Scald was the first cause of burns for children (83.8% for boys and 88.2% for girls among 0–4 years) and for women whatever the age. Fire and flames burns were the first cause of burns for men after 15 (42.6% among 15–59 years, 56% among 60 years and older). Conclusions For the first time in France, this study provides results about causes of burns at a large-scale. In spite of numerous prevention measures, burns and in particular scald, are very frequent in France. Further research aiming at improving knowledge about causes of burns could be useful to better target prevention measures. Moreover, a precise evaluation of prevention measures already implemented could be useful.

Sports-related traumatic deaths in mainland France in 2016

Introduction Although it is recognized that physical exercise is beneficial for health, by increasing the quality of life, by preventing the occurrence of chronic diseases and improving mental health, sport, can also be responsible for serious injuries which some may lead to death. A first estimation of these sports-related traumatic deaths was led in 2010: 246 deaths; the purpose of this work is to update it. Methods The sources for data collection were: media data sources (Internet, regional daily press), websites of sport federations or association and public agencies involved in sport, collection of firefighters public institution and the ministry of Sports. The death had to be caused by an injury during sport practice from the 1st of January up to the 31st of December 2016 in mainland France. Occupational injuries were not included, cycling, walking and bathing-related deaths were not included unless the notion of sport practice was clearly mentioned. Sports were categorized in seven groups: aircraft motorized sports, aircraft non-motorized sports, hunting, watersports, mechanical sports, mountain sports, other sports. Results In total, 277 sports-related deaths were identified for the year 2016, which represents nearly 5 deaths per week in mainland France. They were mostly men with 87% of deaths (sex ratio M/F of 6.5). They were mostly adults between 30 and 70 years old (66%). 52% of deaths occurred during summertime (June–September), 34% occurred on weekends (Saturday and Sunday). Deaths most often occurred during mountain sports (45%), water sports (16%), aircraft non-motorized sports (11%), aircraft motorized sports (9%), mechanical sports (8%), hunting (4%) and other sports (6%). Conclusions This work has provided an estimate of the number sports-related traumatic deaths in mainland France. Within the limits of the collection method, this number was 277 in 2016. The sports leading to the greatest number of deaths were middle and high mountain sports and water sports. Some cases may have not been collected because of technical difficulties of access to information media, but also when the victims died later after hospitalization, the fate of the victim is not always reported in the media. Similar work was conducted in prospective for the year 2017, in order to access the information media in real time. It will allow minimizing bias of disappearance of online information. Data collection on the circumstances of the accident which led to the death, the risk factors of the person and his environment, his/her level and his/her practice, etc. could provide information to elaborate prevention programs.

455 Unintentional injuries in schoolchildren in France: contribution of three surveys at 6, 10 and 15 years

Background Unintentional injuries need to be better studied to be avoided, as they are responsible for 25,000 deaths per year in France, including one a day in children under 15 years old. One of the objectives of “school surveys” is to describe these injuries, the conditions of their occurrence, their severity, their consequences in terms of limitations and healthcare, and the factors associated with the injury. Methods The same questionnaire on the occurrence of injuries was used in three nationally representative samples in France: 17,000 schoolchildren aged 5–6 years in 2012–2013, 7,000 schoolchildren aged 10–11 in 2004–2005, and 7,000 students aged 14–15 in 2008–2009. The data were weighted; descriptive and multivariate analyses were performed. Results In the three months preceding the survey, 4% of 5–6 year-olds, and 9% of 10–11 and 14–15 year-olds reported an injury. The proportion of traffic accidents was 10% at 14–15 years, and only 4% at 10–11 years and 2% at 5–6 years. The proportion of fractures was similar among the three samples, representing between 20% and 24%. Sprains increased with age: 8%, 33% and 54%. The head was the most affected part at 5–6 years (57%) and lower limbs at 10–11 years and 14–15 years (41 and 48%). Injuries were more frequent among boys in the three surveys, in middle class children, in children spending less time watching a screen, in children with a history of asthma or practicing a sport activity in the 14–15 years age group, and in overweight children in the 5–6 years age group. They were less frequent in 5–6 years and 10–11 years old children attending school in priority education zones. Conclusions As all the children attend school in France, these results relate to all unintentional injuries of children of one age group. Further specific surveys on the most severe injuries are needed to define preventive actions.

681 Epidemiology of traumatic brain injuries based on hospital reports in metropolitan france: which ICD10 codes should be selected?

Background Traumatic brain injuries (TBI) result most often from injuries which could have been avoided through preventive measures. They have very costly human and financial consequences. To contribute to the epidemiological surveillance of TBI, the objective of this project was to analyse hospitalizations for TBI in France. Methods Each hospitalisation results in a report containing information on the diagnosis, the treatment, the health condition upon discharge, etc. This database, called the Programme for the Medicalization of Information Systems (PMSI), is comprehensive. The main hospital diagnosis (MD) and associated diagnosis (AD) are coded in the International Classification of Diseases, 10th Revision (ICD10). The selections were made from different ICD10 code lists used in the literature: “Intracranial injury” (S06 codes) always selected for TBI analysis; “Fracture of vault of skull, etc.” (S02.0, S02.1, S02.3, S07.1) often retained (OR); “Fracture of skull and facial bones, etc.” (S02.7, S02.8, S02.9, S07.0, S07.8, S07.9, S09.7, S09.8, S09.9) sometimes retained (SR). The selection must be made on all diagnoses (MD and AD), since the TBI can be coded as an AD in case of multiple injuries. Results In 2013, there were 134,546 hospitalizations with at least one diagnosis coded as S06, 8,292 additional hospitalizations coded as OR, and 6,821 hospitalizations coded as SR, representing a total of 149,659 hospitalizations. The fact of adding to the selection of S06 codes hospitalizations with OR codes or hospitalizations with OR and SR codes results in an increasing number of hospitalizations: 6.2% and 11.2% respectively. Conclusions The analysis of hospitalizations for TBI should not be limited to S06 codes because they produce too many false negatives. The analysis of false positives and negatives associated with the addition of OR or OR + SR codes requires the use of a gold standard to conclude on the best selection and estimate hospital morbidity due to TBI.

482 French home and leisure injury permanent survey: what contribution to epidemiological surveillance?

Background The literature and the knowledge regarding home and leisure injury (HLI) are far wider than it used to be a couple of decades ago. Different types of epidemiological surveillance have been carried out: cross-sectional, population, cohort studies. Nevertheless, little is known about detailed circumstances of those injuries. Methods The French HLI permanent survey started in France in 1986 in a dozen of hospital emergency services and is fully standardised since 2004. All patients admitted for HLI are included and detailed information is collected: where, when, how, who, what product is involved as well as the chronology of the injury and the care given. Results In France, like in other countries, several systems provide epidemiological indicators to describe HLI: incidence in population, consumption of health care services, and people at risk. However, when a specific injury needs to be more documented, such as button battery ingestion, trampoline injuries, wasp stings, barbecue burns, traumatic sport injuries, elderly falls, etc., the only system able to provide solid answers in France is the HLI permanent survey, which records around 120 000 annual injuries. The strength of the survey is the robustness guaranteed by the annual quality analysis and evaluations making the figures reliable and allowing time series analysis. Incidence rates can be estimated thanks to sophisticated models. Conclusions For prevention purposes, there are increasing demands about HLI from the Ministry of Health, organisations, and associations. The HLI permanent survey is a key tool to improve knowledge about incidence, severity, preventability, and contributes to the diminution of those injuries through specific prevention initiatives and regulations.

492 Epidemiological surveillance of accidental falls at home among the elderly in France: Chupadom study

Background The frequency of falls among the elderly and their severity represent a major public health issue, whether in terms of deaths, functional or psychological sequelae, and cost. In France, the proportion of elderly people aged 65 years and more represent 18% of the population (12.2 million). Life expectancy at birth is 79.2 years for men and 85.4 years for women. In metropolitan France in 2011, 9,412 deaths due to falls were reported, of which 90% in people aged 65 years old and more with a sex-ratio equal to 0.6. It is necessary to further explore their risk factors for the implementation of effective preventive actions. Methods Patients to be included in the study should be aged 65 years or more, suffering from an accidental fall at home resulting in hospitalisation. Prospective data collection will start in 2016 during six months in several French hospitals emergency services. Standardised questionnaires will collect the circumstances of the falls, socio-economic and demographic status, and health and home characteristics of the patients. A follow-up study will be carried out one year after the fall to evaluate sequelae. Results This study aims at identifying the circumstances of accidental falls at home among the elderly and establishing profiles of fallers with the help of factorial analyses. The second part of the study will analyse the consequences of the falls one year later: recurrent falls, type of sequelae and disability, quality of life, depending on the initial severity of the fall and the profile of the faller. Conclusions This study will contribute to the implementation of adapted preventive measures thanks to the profiles established.