Epidemiology of Trauma in France: Mortality and Risk Factors Based on a National Administrative Health Database

Background: In France, the management of trauma exhibits several peculiarities, including a developed pre-hospital medicalisation and a large number of facilities. However, there is neither a national trauma system nor register. The billing system reflects the entire nation's hospital activity. The study aims at describing, using this database, the epidemiology of French trauma. Methods: A retrospective population-based cohort study has been conducted on trauma patients in France using the French National Uniform Hospital Discharge Data Set Database (PMSI-MCO) for 2016. Patients were selected using the Trauma Audit and Research Network (TARN) criteria, inspired by the UK trauma system. Sociodemographic and clinical information and hospital characteristics were collected. The main outcomes were 24-hour and 30-day mortality. Findings: Among 1 144 596 patients hospitalised in French hospitals for trauma in 2016, 144 058 patients were included in the study based on the TARN criteria. The mean age of the patients was 64 years. Females (50·8%) were over-represented among patients older than 75 years. The 24-hour and 30-day mortality was 1·4% and 5·9%, respectively. The severity of trauma differed according to the type of hospitals; university hospitals admitted severe trauma cases. In multivariate analysis, age, gender, injury body regions, co-morbidities, injury severity, transfusion, need for surgery, and ICU admission were independent factors of risk for both early and delayed mortality. Age and injury severity were the stronger predictors for mortality. Area-level deprivation was an adverse factor for 30-day mortality. Interpretation: The national burden of trauma care was assessed with administrative data in a country without a trauma system. The mortality associated with trauma in France was around 6%. Risk factors include age and severity, but other variables like the socioeconomic status influences the outcomes. Funding: None. Declaration of Interest: The authors have no conflicts of interest to disclose in relation with this manuscript.