Epidemiology of trauma in France: mortality and risk factors based on a national medico-administrative database

Abstract

Introduction: In industrialised countries, trauma is a public health challenge. Despite disposing of a highly evolved and complex health care system, France does not dispose of a national trauma registry or trauma system. Little is known about the epidemiology of trauma in France. This study aims at describing, using the national billing database, the epidemiology of French trauma.

Methods: A retrospective population-based cohort study has been conducted on trauma patients in France using the National Hospital Discharge Data Set Database for 2016. Patients were selected using the Trauma Audit and Research Network (TARN) criteria, inspired by the UK trauma system. Sociodemographic, clinical information and hospital characteristics were collected. The main outcome was 30-day mortality.

Results: Among 1,144,596 patients hospitalised in French hospitals for trauma in 2016, 144,058 patients were included based on the TARN criteria. The mean age of the patients was 64 years (± 24). Women (50.8%) were over-represented among patients older than 75 years. The 30-day mortality was 5.9%, and regional variations were identified. In multivariate analysis, age, gender, area-level deprivation, injury localisation, co-morbidities, injury severity, transfusion, surgery, and ICU admission were independent factors of risk for 30-day mortality. Age and injury severity were the stronger predictors for mortality and area-level deprivation was associated with higher mortality.

Conclusion: The national burden of trauma care was assessed with medico-administrative data in a country without a trauma system. The 30-day mortality associated with trauma in France was around 6%, with regional variations.

Keywords: Administrative; Database; Global public health; Socioeconomic; Trauma.