French home and leisure injury permanent survey: What contribution to epidemiological surveillance?

Introduction The literature and knowledge regarding home and leisure injuries (HLI) are far wider than they used to be a couple of decades ago. Each year in France (65 million of inhabitants), 14 million of admissions are registered in the 730 emergency departments (ED), of which 5 million are HLI. Different types of epidemiological surveillance have been carried out: cross-sectional, population, cohort studies. Nevertheless, little is known about the detailed circumstances of those injuries. The French home and leisure injury permanent survey (“Enquete permanente sur les accidents de la vie courante” - EPAC) provides detailed circumstances of HLI. Methods The French HLI permanent survey started in France in 1986 in a dozen of hospital emergency services and is fully standardized since 2004. All patients admitted for HLI are included. When patients arrive at an ED for HLI, they are informed by medical staff that they will be part of this survey, at this point they can refuse to participate (which happens very rarely). After consenting, patients are included and detailed information is collected: where, when, how, who, what product is involved as well as the chronology of the injury and the care given. Data collected in a fixed format in each hospital are centralized each month at national level. Results In France, like in other countries, several systems provide epidemiological indicators to describe HLI: incidence in population, consumption of health care services, and people at risk. However, when a specific injury needs to be more documented, the only system able to provide solid answers in France is the HLI permanent survey, which records around 120,000 annual injuries. EPAC database allowed providing many results on HLI: button battery ingestion, trampoline injuries, wasp stings, barbecue burns, traumatic sport injuries, elderly falls, traumatic brain injuries, ingestion of cannabis, etc. The strength of the survey is the robustness guaranteed by the annual quality analysis and evaluations making the figures reliable and allowing time series analysis. Incidence rates can be estimated thanks to different methods, including sophisticated models. Conclusion EPAC survey provides details regarding circumstances and products that cannot be found anywhere else in France. Ancillary studies can be run to deepen specific topics: dog bites, outcome of mild traumatic brain injured patients, sequelae of falls among elderly, etc. The possible link with hospitalization databases allows analyzing the most severe HLI. For prevention purposes, there are increasing demands about HLI from the Ministry of Health, organizations, and associations. The EPAC survey is a key tool to improve knowledge about incidence, severity, preventability, and contributes to the diminution of those injuries through specific prevention initiatives and regulations.