Epidemiology of traumatic brain injuries based on hospital reports in mainland France

Abstract

Introduction Traumatic brain injuries (TBI) are defined as an alteration in brain function or other evidence of brain pathology caused by an external force. Every year in mainland France, TBI are responsible for several hundreds of deaths and several thousands are treated at emergency departments. Among them, between 25% and 40% result in physical, psychological or social sequelae according to different estimations. TBI occur, most often, after a home and leisure injury or a traffic accident, which could have been avoided by appropriate prevention measures. Few epidemiological data on TBI at a large-scale exist in France. Thus, these analyses aim at gaining new insights into TBI epidemiology in France using data from the hospital nationwide database - “Programme de Medicalisation des Systemes d’Information” (PMSI). Methods The analysis was performed on all the first hospital stays in 2013 in mainland France registered in the PMSI database with a principal or associated diagnosis of TBI, coded in S06 in the International Classification of Diseases, 10th revision (ICD10). S06 codes are the only one specific to TBI in the ICD10. Data collected for patients whatever the age included: demographics, type of injury (concussion, edema, hemorrhage, etc.), vital status at the end of hospitalization. The evolution of two indicators (Incidence rate and lethality rate) was studied over the period 2011–2013. Results In 2013, 135,081 patients were hospitalized after the occurrence of TBI, mostly men (57% of patients) with a mean/median age of 49/53, presenting mostly mild TBI (77%). Incidence rate was 206 per 100,000 inhabitants, more elevated among men than among women (242 per 100,000 versus 172 per 100,000). TBI were more frequent among young and the elderly. Incidence rates varied according to the regions but remained stable over the period 2011–2013. 5,723 patients died during their hospitalization. The lethality rate was 4% (4.2% for men versus 3.7% for women). Lethality rate increased with age for men and women and remained stable over the period 2011–2013. Conclusions For the first time in France, this study provides results about TBI at a large-scale. Incidence rate measure in France is in the range of incidence rates calculated in studies based on hospital discharge. These results contribute to improve TBI epidemiological monitoring in France. Other sources of data, like emergency data, will be necessary in order to measure more accurately the number of victims of TBI and in particular of mild TBI. Furthermore, research aiming at improving knowledge about precise causes of TBI could be useful in order to expand effective TBI prevention measures.