Non-COVID activity in French emergency department during COVID-19 pandemic (March 2020 to March 2022)

Background

The COVID-19 epidemic and mitigation actions had major impacts on health and healthcare use by the French population. Since 2004, the French public health agency daily collects individual data of visits in the emergency departments (ED) OSCOUR® network (94% of national visits in 2022). We aimed to analyse the evolution of non-Covid ED visits from 2020 to March 2022, in order to identify potential indirect impact of the epidemic.

Methods

The main medical diagnosis (MD) coded in ICD-10 from each ED visit from 2017 to March 2022 was classified into 17 ICD-10 chapters and in 95 disjoint subgroups of pathologies. The observed numbers of ED visits by age group and by chapters/subgroups were compared to expected numbers, estimated using an overdispersed Poisson regression model based on 2017-2019 data.

Results

The observed numbers of ED visits for all chapters and for a large part of subgroups were significantly lower than the expected numbers during the three lockdowns in all age groups and progressively returned to the expected level in 2021. A change in the pattern of a limited list of subgroups was observed: ED visits for purpura, chronic blood diseases and neurologic disorders in children decreased during the first lockdown and remained under the expected level until March 2022. Inversely the number of ED visits for mental health and wheezing in children, for pulmonary embolism in adults and for neoplams in the elderly increased and remained over the expected values until 2022.

Conclusions

Syndromic ED system was a pillar of the French reactive surveillance of direct and indirect impacts of COVID-19 epidemic. The changes observed for different subgroups of pathologies may reflect a negative impact of the epidemic, a positive effect of protective measures on the spread of other infectious diseases, a modification in the organization or in the use of health care in specific domains. Further studies using hospitalization data could explore these hypotheses.

Key messages

• Existing syndromic surveillance system implemented before the emergence of SARS-COV2 enabled to monitor non-Covid-19 visits to emergency departments and assess changes in patterns of pathologies.

• An increase in the number of emergency department visits during the COVID-19 epidemic was observed for mental health in children, for pulmonary embolism in adults and for neoplams in the elderly.

Reactive surveillance of suicides during the COVID-19 epidemic in France, 2020- March 2022

Background

Mitigation actions during the COVID-19 pandemic, in particular lockdowns and curfews, may impact mental health and suicide in general populations. We aimed to analyse the evolution in suicide deaths from January 2020 to March 2022 in France.

Methods

Using free-text medical causes in death certificates, we built an algorithm, which aimed to identify suicide deaths. We measured its retrospective performances by comparing suicide deaths identified using the algorithm with deaths which had either an ICD10 code for ‘intentional self-harm’ or for ‘external cause of undetermined intent’ as underlying cause. The number of suicide deaths from January 2020 to November 2021 was then compared with the expected number estimated using a generalized additive model. The analysis was stratified by age group and gender. Analysis from December 2021 to March 2022 was conducted using electronic death certificates only.

Results

The free-text algorithm demonstrated high performances. From January 2020 to November 2021, suicide mortality declined during France's three lockdowns, particularly in men, and remained quite comparable with expected values between and after both of the country's lockdowns. Provisional results based on electronic death certificates suggest that suicide mortality remained stable until March 2022.

Conclusions

Monitoring suicide mortality is possible in France with a 4-month delay; this will be reduced to two days when electronic death certification is fully deployed. This study highlighted the absence of an increase in suicide mortality during France's COVID-19 pandemic, and a substantial decline during lockdowns periods, something already observed in other countries. Further studies are required to explain the factors for this decline.

Key messages

• In the absence of reactive coding of medical causes of deaths, the study proposed an approach to reactively identify suicide based on free-text medical causes from death certificates.

• Our findings provide reassurance that the COVID-19 pandemic has not had a negative impact on the general population in terms of suicide in France from March 2020 to September 2021.

Public Health Tracking to address the complexity of environmental health: The case of France

To address the complex relationship between environment and health, public-health professionals have recognized the benefits of building enduring interdisciplinary partnerships and of developing innovative Environmental and Public Health Tracking (EPHT) systems. In specific, EPHT can increase understanding of environmental health threats; improve comparability of risks between different areas of the world; enable transparency and trust among citizens and institutions; and inform preventive decision making. EPHT does so by sharing data and knowledge; and by identifying and supporting best practices.

In France, the concept of EPHT builds on the observation that our changing environment creates new risks that require both specific surveillance of the link between exposure and health indicators, and syndromic surveillance (SyS) of sentinel health indicators. A specific surveillance of air pollution and health has been informing French policies on air pollution for 23 years. France has also coordinated the European Apheis and Aphekom specific-surveillance projects. Using routine pollution and health data, these projects succeeded by being built on a Europe-wide collaborative network that facilitates decision-making on local and national levels.

In addition, since the 2003 heat wave France has developed syndromic surveillance for detecting the health impacts of new threats as diverse as environmental phenomena and emerging infectious diseases. France also coordinated the Triple-S project, which inventoried SyS activities in Europe; and produced guidelines for human and veterinary SyS in Member States and a proposal for a European SyS strategy. Examples of the complementarity between specific and SyS in environmental health in France include: heat and cold waves, air pollution, flooding, storms and industrial accidents. In today's world of open data, EPHT shows great promise for contributing to better informing decision makers and the population on environmental-health risks.

Key messages

Environmental and Public Health Tracking (EPHT) systems and enduring interdisciplinary partnerships provide an innovative way to address the complex relationship between environment and health. France has been in the forefront of applying innovative EPHT (Environmental and Public Health Tracking) by using complementary specific and syndromic (SyS) surveillance systems.

Description of low back pain attendances in French ED

Background

Low back pain (LBP) is one of the leading contributors to disease burden worldwide [1]. In 2018, French health care insurance launched a population awareness campaign in order to promote effective behaviour change in France. Because LBP acute episodes often lead to emergency visits, Santé publique France, the French Public Health Agency and the Federation of Observatories for Emergency Medecine, performed a pre-campaign situational analysis of LBP in the French emergency department (ED) involved in the OSCOUR® network.

Methods

The OSCOUR network is part of the French syndromic surveillance system SurSaUD® [2] coordinated by Santé publique France since 2004. In 2017, the system collects daily individual data from about 700 ED representing 92% of the French ED attendances. Those data contain demographic, administrative and medical information including discharge diagnosis coded according ICD-10. ED attendances with a diagnosis related to LBP were analyzed from 2014 to 2017. Temporal distribution of LBP attendances, hospitalizations after discharge and stay duration in ED services were also analyzed.

Results

From 2014 to 2017, 504 ED were included in the analysis and LBP represented 1.12% (N = 481,291) of ED all visits. This proportion remained stable over the period. 60% of LBP attendances concerned 18 to 50 years old adults and almost 10% were hospitalized after discharge. This proportion increased with age to reach 43% for the 85 years old and more. LBP attendances were more frequent on Monday. Median stay duration were almost 3 hours but increased with age and for hospitalized patients.

Conclusions

The broad coverage of the ED OSCOUR® network on the whole territory and the strong partnership between epidemiologists and clinicians enable Santé publique France to produce reliable results which are also consistent with ED physician’s perception. Finally those results can be used as a reference contributing to evaluate potential benefits of this campaign.

Key messages

This description of low back pain ED attendances is consistent with emergency physicians perception on field and can be used as a reference to evaluate potential benefits of the prevention campaign. The national coverage of the ED OSCOUR® network and the strong partnership with emergency physicians enable Santé publique France to produce relevant description on the main causes of ED attendances.

Monitoring measles outbreaks using emergency department data in France

Background

Measles’ outbreaks still occur in industrialised countries and reactive monitoring of the disease is needed. In France, measles’ monitoring is based on a mandatory notification (MN).

Methods

In France, for each emergency department (ED) visit, an Electronic ED Abstract (EEDA) is transmitted to the OSCOUR® network included in national Syndromic Surveillance System. EEDA include the diagnosis at discharge using International Classification of Disease (ICD-10). This study aims to evaluate the correlation between the number of measles MN and the number of ED visits related to measles and to calculate the positive predictive value (PPV) of diagnosis at discharge of measles in ED. The study period covered the third wave of the 2008-2011 French outbreak. From 2010 to 2011, we analyzed EEDA transmitted from 32/53 ED of the PACA region and regional measles MN. Using weekly aggregated data, the correlation between the number of measles cases given by both MN and ED sources was assessed (Pearson coefficient). In the 4 ED (2 pediatric) of the teaching hospital of Marseille, electronic medical files coded as measles were reviewed to evaluate the PPV of the diagnosis coded according to the national MN case definition (gold standard).

Results

2,949 MN were transmitted and 1,306/1.3 million visits in ED were coded as measles. The peak of the outbreak was reported the same week by EEDA and MN. The correlation between EEDA and MN was strong (0.91; p < 0.001). Hospitalization rate was 20.7% and 21.0% according to EEDA and MN (p = 0.81). Among 363 medical files coded as measles in the 4 ED, 14 cases (3.9%) did not fulfilled the national case definition (PPV: 96.1 [IC95%: 94.2-98.1]), 86 (23.7%) fulfilled criteria for “clinical case” and 263 (72.5%) for “confirmed case".

Conclusions

Most of the time, ED visits coded as measles fulfilled diagnosis criteria. Our results suggested that EEDA (better reactivity) could be complementary to MN (better completeness) to monitor measles.

Key messages

Most of the time, ED visits coded as measles fulfilled diagnosis criteria: PPV of coded medical diagnosis in ED for measles is high. Reactivity of ED data monitoring could usefully complete mandatory notification for measles surveillance.

Alcohol-related attendances in French emergency departments in 2017

Background

France is one of the leading countries in terms of daily alcohol consumption per inhabitant. Alcohol is a major concern for emergency department (ED) since it accounts for a large part of their resources and increases behavior problems resulting in violence against staff. Individual information of French ED attendances registered in OSCOUR network are daily collected by Santé publique France, the French Public Health Agency. This study aims at describing alcohol-related ED attendances (ARA) in 2017 in France.

Methods

The OSCOUR network included 677 ED in 2017 recording 92% of national attendances. ARA were identified through the main and associated medical diagnoses coded by physicians using ICD10. The study considered acute alcohol intoxication, dependence syndrome/withdrawal state, other mental disorders and intoxications due to alcohol, chronic complications and intentional self-poisoning by alcohol. The number of ARA was analyzed by age group, gender and region.

Results

1.4% of total attendances were associated to alcohol consumption (202,184 attendances) in 2017. 68% of ARA were due to acute alcohol intoxication and 14% for dependence syndrome/withdrawal state. The highest proportions of ARA were observed for people aged 40-59 yo and 18-24 yo, particularly for women. Regions of North and West metropolitan France and La Réunion Island had the highest proportion of ARA among the total number of attendances.

Conclusions

The part of ARA in France is consistent with figures provided in international studies using similar data. This proportion is similar with proportion of major public health issues like influenza, that represented 1% of the total ED attendances from November 2016 to February 2017 and reached 1.8% in January (month of the epidemic peak). Consequences of alcohol use represent a heavy burden for ED and the health system in France. This is all the more true as ARA are underestimated due to the low coding rate of associated medical diagnosis in ED.

Key messages

1.4% of total French ED attendances were associated to alcohol consumption in 2017. This proportion is close to the proportion of influenza attendances in ED.

Géodes: the health indicators web portal of the French Public Health Agency

Background

Santé publique France, the French Public Health Agency, produce numerous health indicators (diseases or health determinants) from many different data sources (specific or unspecific surveillance systems, epidemiological and behavioural surveys, administrative databases). In order to improve visibility and accessibility of these indicators, a web portal “Géodes” was created.

Methods

Géodes was built with Géoclip Air© developped by a French start-up. This ergonomic tool allows to explore the geographical dimension of health indicators through interactive maps along with graphs and tables. In addition, Géodes is designed to explore the temporal dimension of indicators produced yearly or weekly through dynamic maps or time series. All indicators are linked to an explanatory sheets. Description, sources, precisions or limits of interpretation are discribed. It is also easy to present indicators in interactive tables, exportable in different formats such as Excel spreadsheets.

Results

Since February 1st 2019, Géodes is available online without any access restriction (https://geodes.santepubliquefrance.fr). Over 300 health indicators are provided related to infectious and chronic diseases, occupational and environmental health, behaviours, emergency departement attendances, etc. An indicator is either a number of cases, a proportion or an incidence rate. Most indicators are stratified by categories such as sex or age group. It is possible to represent two indicators on a single map, e.g. the smoking prevalence and the standardised rate of lung cancer.

Conclusions

The days following the opening to the public, the site recorded up to 10,000 connections per day. In routine, the site knows up to 200 visits per day, up to 3,000 in case of quoting aparticular indicator in the media. These figures show that this health data observatory meet a real need.

Key messages

A web portal of health indicators created by Santé Publique France is now available. More than 300 health indicators are integrated in the portal. Indicators can be visualized through interactive maps, tables and time series and their values are easily exportable and communicable.

Ten years experience of syndromic surveillance for civil and military public health, France, 2004-2014

Binary file ES_Abstracts_Final_ECDC.txt matches