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Objective The study describes the characteristics of attendances for low back pain (LBP) in the French emergency departments (ED) network Oscour®, in order to give an overview of this disease before launching a prevention campaign. Introduction LBP is one of the leading contributors to disease burden worldwide [1]. In France, LBP is a frequent reason of general practice consultations. According to a study published in 2017 and based on 2014 data issued of the National Health Insurance Cross-Schemes Information System (Sniiram) [2], this pathology stands for 30% of thickness leave and 4 of 5 people will suffer of low back pain during their own life. Most often, LBP is a chronic pathology with acute episodes which most often require emergency care. In order to prevent chronicity, French health care insurance launched into a mainstream national prevention campaign during spring 2018. This campaign was also targeted for health professional to inform them of the best recommendations to provide to their patients. Then the French society of emergency medicine (SFMU) has been asked to relay this campaign to emergency departments (ED) where LBP is a frequent reason of attendance. Since 2004, the French syndromic surveillance system SurSaUD® [3] coordinated by the French Public Health Agency (Sante publique France) daily collects morbidity data from the emergency departments (ED) network Oscour®. Almost 92% of the French ED attendances were recorded by the system in 2017. The availability of this large ED dataset on the whole territory since several years gives the opportunity to describe LBP attendances before the potential fallout of the national prevention campaign. Methods For each ED attendance, the SurSaUD® system daily collects individual data containing demographic (age, gender, zip code), administrative (ED unit, date of attendance, transport…) and medical information (medical diagnosis (ICD10), chief complaint, severity, hospit.). These data are routinely analyzed to detect and follow-up various expected or unusual public health events all over the territory [3] and also constitute a large database to perform in-depth studies on specific public health issues. ED attendances with a medical diagnosis of LBP have been identified using at least one of the following ICD10 codes “M545”, “M5450”, “M5456”, “M5457”, “M5458”, “M5459”. Those data have been analyzed from 01/01/2014 to 31/12/2017 (504 ED) for the following age groups; less than 18 years old (yo), 18 to 34 yo, 35 to 49 yo, 50 to 64 yo, 65 to 84 yo and 85 yo and over, at national and regional levels. ED attendances have been also described by month, day of week and hour of day. Hospitalizations after discharge, stay duration in ED services, transport and associated diagnoses were also analyzed. Results From 2014 to 2017, 481,291 ED attendances for LBP were recorded corresponding to 1.12% of the total number of ED attendances with a coded diagnosis. 60% of annual ED attendances for LBP concern 18 to 50 years old adults. The proportion of LBP attendances among the all-cause activity remains stable between 2014 and 2017. At the regional level, LBP proportion among the all-cause activity is similar to the national value in metropolitan regions (0.8% in Brittany to 1.6% in Corsica) and is lower than the national value in overseas regions (0.4% in Mayotte to 0.8% in Guyane) except for Saint-Barthelemy (1.8%). At the national level, almost 10% of ED attendances for LBP are hospitalized after discharge. This proportion increases with age to reach 43% for the 85 years old and more. Proportion of hospitalization ranges between 5.6% (in Paris area) and 17.1% (in Brittany) in metropolitan regions and between 2.8% (Guyane) and 9.3% (Reunion island) in overseas regions. From 2014 to 2017, ED attendances for LBP remain stable by month. However, we observed a slight decrease along the week with more attendances on Monday (17.8% of LBP attendances) than the other days. The attendances are more frequent in the morning (between 6 and 12 AM). At the national level, mean stay duration for LBP attendances in ED is almost 5 hours whereas median stay duration is 2 hours and 45 minutes. Stay duration is longer for patient arrived during night hours (from midnight to 6 AM) and for those hospitalized after discharge. Stay duration is also increasing with age. At the regional level, mean stay duration varies from 3 to more than 6 hours. Conclusions The broad coverage of the French ED network on the whole territory since several years enables to give an overview of ED attendances for acute LBP and their characteristics. One strength of the system is its strong partnership between epidemiologists and the ED physicians. It enables to verify that the results of the study are consistent with their perception on the field. The results of this study will be used as reference to evaluate potential benefits of this campaign. Finally, this study is a good illustration of how the syndromic surveillance system in collaboration with ED physicians, can quickly provide valuable data to support political strategies. References [1] Maher et al, Non-specific low back pain Lancet 2017; 389: 736–47 Published Online October 10, 2016, http://dx.doi.org/10.1016/ S0140-6736(16)30970-9 [2] Assurance Maladie, Le patient adulte atteint de lombalgie commune; Livret d’information Octobre 2017 donnees SNIRAAM 2014, https://www.ameli.fr/sites/default/files/Documents/346618/document/lombalgie-professionnels-de-sante_assurance-maladie.pdf [3] Caserio-Schonemann C, Bousquet V, Fouillet A, Henry V, pour l’equipe projet SurSaUD®. Le systeme de surveillance syndromique SurSaUD®. Bull Epidemiol Hebd. 2014;(3-4):38-44.

International audience

Objective To evaluate whether SAMU data could be relevant for health surveillance and proposed to be integrated into the French national syndromic surveillance SurSaUD® system. Introduction The syndromic surveillance SurSaUD® system developed by Sante publique France, the French National Public Health Agency collects daily data from 4 data sources: emergency departments (OSCOUR® ED network) [1], emergency general practioners (SOS Medecins network), crude mortality (civil status data) and electronic death certification including causes of death [2]. The system aims to timely identify, follow and assess the health impact of unusual or seasonal events on emergency medical activity and mortality. However some information could be missed by the system especially for non-severe (absence of ED consultation) or, in contrast, highly severe purposes (direct access to intensive care units). The French pre-hospital emergency medical service (SAMU) [3] represents a potential valuable data source to complete the SurSaUD® surveillance system, thanks to reactive pre-hospital data collection and a large geographical coverage on the whole territory. Data are still not completely standardized and computerized but a governmental project to develop a national common IT system involving all French SAMU is in progress and will be experimented in the following years. Methods A pilot study was performed in the South of France PACA region, where data from the six local SAMU structures are centralized into an interconnected database. A minimal set of variables required for health monitoring (administrative and medical items) and modalities for data extraction and transmission to Sante publique France were defined. SAMU data were transmitted daily to Sante Publique France and the PACA regional team developed a Microsoft Access® application to import decrypted data, request database and analyze indicators. Retrospective part of the study was performed over a 2-year period (2013-2014) and the prospective part during 2015 was based on daily data collection. Completeness and quality of variables were analyzed. SAMU indicators including several level of specificity were built and compared to existing SurSaUD® indicators in different situations (for detection, seasonal follow-up and health impact assessment) using Spearman coefficient correlation. Results During the pilot study, data from five of the six SAMU structures of PACA region were structured enough to be analyzed. On the study period, almost 2,400,000 files were recorded and 89% contain medical information. Data completeness was high (87%) and stable during the whole period. The annual rate of SAMU solicitation was 16 for 100 inhabitants at the regional scale. 15% of the records were opened only for medical advice. In contrast, patients were evacuated directly in intensive care unit in 9.5% of cases without ED admission. Coding quality depended on the existence and the use of official thesauri and varied widely among SAMU structures. Despite coding variations, SAMU indicators for winter epidemics were significantly correlated with ED and SOS Medecins indicators. Respectively with ED flu, bronchiolitis and gastroenteritis indicators, the strongest correlations were found for SAMU lower respiratory infection (0.74), SAMU bronchiolitis (0.72) and SAMU gastroenteritis / diarrhea / vomiting (0.81). Conclusions This pilot study demonstrated the feasibility to collect daily SAMU activity data. The key strengths of SAMU data were a large geographic coverage, the subsidiarity with SurSaUD® system data sources, the follow-up of prehospital activity and for patients directly admitted into an intensive care unit. Some limitations were highlighted related to differences in coding practices especially for medical diagnosis. The generalization of this study will require the standardization of coding practices and homogenization of thesaurus. The implementation of the national SAMU information system should allow in a very next future to widely progressing on these topics. References [1] Fouillet A, Bousquet V, Pontais I, Gallay A and Caserio-Schonemann C. The French Emergency Department OSCOUR Network:Evaluation After a 10-year Existence. Online Journal of Public Health Informatics ISSN 1947-2579-7(1):e74, 2015 [2] Caserio-Schonemann C, Bousquet V, Fouillet A, Henry V. Le systeme de surveillance syndromique SurSaUD (R). Bull Epidemiol Hebd 2014;3-4:38-44. [3] Baker, D.J.. The French prehospital emergency medicine system (SAMU): An introduction (2005) CPD Anaesthesia, 7 (1), pp. 20-25.

International audience; Introduction: Particulate matter, nitrogen dioxide (NO2) and ozone are recognized as the three pollutants that most significantly affect human health. Asthma is a multifactorial disease. However, the place of residence has rarely been investigated. We compared the impact of air pollution, measured near patients' homes, on emergency department (ED) visits for asthma or trauma (controls) within the Provence-Alpes Cote-d'Azur region. Methods: Variables were selected using classification and regression trees on asthmatic and control population, 3-99 years, visiting ED from January 1 to December 31, 2013. Then in a nested case control study, randomization was based on the day of ED visit and on defined age groups. Pollution, meteorological, pollens and viral data measured that day were linked to the patient's ZIP code. Results: A total of 794,884 visits were reported including 6250 for asthma and 278,192 for trauma. Factors associated with an excess risk of emergency visit for asthma included short-term exposure to NO2, female gender, high viral load and a combination of low temperature and high humidity. Conclusion: Short-term exposures to high NO2 concentrations, as assessed close to the homes of the patients, were significantly associated with asthma-related ED visits in children and adults. (c) 2017 Elsevier Ltd. All rights reserved.