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

Bège, Thierry; Pauly, Vanessa; Orléans, Veronica; Boyer, Laurent; Léone, Marc

doi:10.1016/j.accpm.2019.02.007

Cited by 19 publications

(14 citation statements)

References 28 publications

(38 reference statements)

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“…The first major finding of our study is the increased mortality rate of 5.1-5.7% in people with bipolar disorder or schizophrenia versus 3.3-3.8% in their respective controls. However, these mortality rates are lower than that of our entire database (5.9%), 14 probably due to the exclusion of dementia diagnoses. Indeed, this exclusion may have decreased the mean age, comorbidities and trauma severity in our sample.…”

Section: Discussioncontrasting

confidence: 77%

“…Trauma patients were identified in accordance with a previous French study. 14 Trauma patients were first identified using a code of trauma (beginning with S or T according to the ICD-10 chapter ‘Injury, Poisoning and Certain Other Consequences from External Causes’) as the principal diagnosis of admission into an acute care unit. Second, we selected patients using the Trauma Audit & Research Network (TARN) criteria 15 (for more details, see 16 ).…”

Section: Methodsmentioning

confidence: 99%

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Trauma-related mortality of patients with severe psychiatric disorders: population-based study from the French national hospital database

et al. 2019

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Background Most research on mortality in people with severe psychiatric disorders has focused on natural causes of death. Little is known about trauma-related mortality, although bipolar disorder and schizophrenia have been associated with increased risk of self-administered injury and road accidents. Aims To determine if 30-day in-patient mortality from traumatic injury was increased in people with bipolar disorder and schizophrenia compared with those without psychiatric disorders. Method A French national 2016 database of 144 058 hospital admissions for trauma was explored. Patients with bipolar disorder and schizophrenia were selected and matched with mentally healthy controls in a 1:3 ratio according to age, gender, social deprivation and region of residence. We collected the following data: sociodemographic characteristics, comorbidities, trauma severity characteristics and trauma circumstances. Study outcome was 30-day in-patient mortality. Results The study included 1059 people with bipolar disorder, 1575 people with schizophrenia and their respective controls (n = 3177 and n = 4725). The 30-day mortality was 5.7% in bipolar disorder, 5.1% in schizophrenia and 3.3 and 3.8% in the controls, respectively. Only bipolar disorder was associated with increased mortality in univariate analyses. This association remained significant after adjustment for sociodemographic characteristics and comorbidities but not after adjustment for trauma severity. Self-administered injuries were associated with increased mortality independent of the presence of a psychiatric diagnosis. Conclusions Patients with bipolar disorder are at higher risk of 30-day mortality, probably through increased trauma severity. A self-administered injury is predictive of a poor survival prognosis regardless of psychiatric diagnosis. Declaration of interest None.

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Section: Discussioncontrasting

confidence: 77%

Section: Methodsmentioning

confidence: 99%

Trauma-related mortality of patients with severe psychiatric disorders: population-based study from the French national hospital database

et al. 2019

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“…(11) In terms of severe injuries, we found a 19.6% crude 30-day mortality of patients aged ≥ 16 years with ISS > 15. Several European studies (7,25,29) and a study from Hong Kong(26) have showed a 30-day mortality of trauma patients with ISS > 15 varying between 14.9% and 22.4%. In Japan, the in-hospital mortality of adult trauma patients with ISS ≥ 16 decreased from 28.5% in 2004 to 15.7% in 2013.…”

Section: Mortalitymentioning

confidence: 99%

Ten-Year Trends of Adult Trauma Patients in Denmark from 2010 to 2019: A Retrospective Cohort Study

Trier¹,

Fjølner

Raaber

et al. 2021

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Background: Trauma causes a considerable economic and societal burden and the trauma patient population and its prognosis changes over time. The aim of this study is to analyze ten-year trends of trauma patients at a major trauma center in Denmark. Methods: 5366 patients aged ≥ 16 years with Injury Severity Score (ISS) > 0 admitted by trauma team activation at Aarhus University Hospital Trauma Center between January 1, 2010 and December 31, 2019 were included. Descriptive statistics, incidence rate calculation, parametric and non-parametric test were used. An annual percent change with 95% confidence interval was used to estimate trend in mechanism of injuries. Multiple logistic regression with mortality as outcome were adjusted for age, sex and ISS. Results: The median age increased from 37 in 2010 to 49 in 2019 and the proportion of patients aged ≥ 65 doubled. The incidence of minor injuries (ISS 1-15) decreased from 181.3/105 inhabitants in 2010 to 112.7/105 in 2019 corresponding to an incidence rate ratio between 2019 and 2010 of 0.62 (95% CI: 0.54 to 0.72). Severe injuries (ISS > 15) increased from 10.1/105 inhabitants in 2010 to 13.6/105 in 2019 corresponding to an incidence rate ratio between 2019 and 2010 of 1.35 (95% CI: 1.04 to 1.76). The proportion of patients with ISS > 15 increased from 18.1% in 2010 to 31.1% in 2019. Multivariable logistic regression showed lower 30-day mortality for all trauma patients with ISS > 0 over the study period when adjusting for age, sex and ISS (Odds ratio: 0.94, 95% CI: 0.90 to 0.99). The 30-day mortality for severely injured patients with ISS > 15 decreased during the study period when adjusting for age, sex and ISS (Odds ratio: 0.92, 95% CI: 0.87 to 0.97). Fall injuries increased with an annual percent change of 4.1% (95% CI: 2.3% to 6.1%). Conclusions: Ten-year trends of trauma patients in Central Denmark Region show an increasing median age, injury severity and number of fall injuries. The 30-day mortality of trauma patients decreased for both minor injuries and severe injuries when adjusting for age, sex and injury severity. Trial registration: Not applicable.

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“…Major trauma is the leading cause of mortality among patients admitted in the intensive care unit (ICU) [1]. Two components affect the outcome of trauma patients: organ damage due to direct trauma and post-traumatic systemic inflammation progressing to multiorgan failure [2].…”

Section: Introductionmentioning

confidence: 99%

Circadian disruption of core body temperature in trauma patients: a single-center retrospective observational study

et al. 2020

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Background: Circadian clock alterations were poorly reported in trauma patients, although they have a critical role in human physiology. Core body temperature is a clinical variable regulated by the circadian clock. Our objective was to identify the circadian temperature disruption in trauma patients and to determine whether these disruptions were associated with the 28-day mortality rate. Methods: A retrospective and observational single-center cohort study was conducted. All adult severe trauma patients admitted to the intensive care unit of Aix Marseille University, North Hospital, from November 2013 to February 2018, were evaluated. The variations of core body temperature for each patient were analyzed between days 2 and 3 after intensive care unit admission. Core body temperature variations were defined by three parameters: mesor, amplitude, and period. A logistic regression model was used to determine the variables influencing these three parameters. A survival analysis was performed assessing the association between core body temperature rhythm disruption and 28-day mortality rate. A post hoc subgroup analysis focused on the patients with head trauma. Results: Among the 1584 screened patients, 248 were included in this study. The period differed from 24 h in 177 (71%) patients. The mesor value (°C) was associated with body mass index and ketamine use. Amplitude (°C) was associated with ketamine use only. The 28-day mortality rate was 18%. For all trauma patients, age, body mass index, intracranial hypertension, and amplitude were independent risk factors. The patients with a mesor value < 36.9°C (p < 0.001) and an amplitude > 0.6°C (p < 0.001) had a higher 28-day mortality rate. Among the patients with head trauma, mesor and amplitude were identified as independent risk factors (HR = 0.40, 95% CI [0.23-0.70], p = 0.001 and HR = 4.73, 95% CI [1. 38-16.22], p = 0.01). Conclusions:Our results highlight an association between core body temperature circadian alteration and 28-day mortality rate. This association was more pronounced in the head trauma patients than in the non-head trauma patients. Further studies are needed to show a causal link and consider possible interventions.

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

Cited by 19 publications

References 28 publications

Trauma-related mortality of patients with severe psychiatric disorders: population-based study from the French national hospital database

Trauma-related mortality of patients with severe psychiatric disorders: population-based study from the French national hospital database

Ten-Year Trends of Adult Trauma Patients in Denmark from 2010 to 2019: A Retrospective Cohort Study

Circadian disruption of core body temperature in trauma patients: a single-center retrospective observational study

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