0000000000527783
AUTHOR
Eric Benzenine
Hospitalizations for Stroke in France During the COVID-19 Pandemic Before, During, and After the National Lockdown.
Background and Purpose: In France, the entire population was put under a total lockdown from March 17 to May 11, 2020 during the peak of the coronavirus disease 2019 (COVID-19) pandemic. Whether the lockdown had consequences on the management of medical emergencies such as stroke and transient ischemic attack (TIA) has yet to be fully evaluated. This article describes hospitalization rates for acute stroke in 2 French regions that experienced contrasting rates of COVID-19 infection, before, during, and after the nationwide lockdown (January to June 2020). Methods: All patients admitted for acute stroke/TIA into all public and private hospitals of the 2 study regions were included. Data wer…
How accurate is the reporting of stroke in hospital discharge data? A pilot validation study using a population-based stroke registry as control.
Population-based stroke registries can provide valid stroke incidence because they ensure exhaustiveness of case ascertainment. However, their results are difficult to extrapolate because they cover a small population. The French Hospital Discharge Database (FHDDB), which routinely collects administrative data, could be a useful tool for providing data on the nationwide burden of stroke. The aim of our pilot study was to assess the validity of stroke diagnosis reported in the FHDDB. All records of patients with a diagnosis of stroke between 2004 and 2008 were retrieved from the FHDDB of Dijon Teaching Hospital. The Dijon Stroke Registry was considered as the gold standard. The sensitivity, …
Chirurgie combinée de la cataracte et endophtalmie postopératoire aiguë en France de 2005 à 2014
Introduction : L’objectif de cette étude était d’analyser l’association entre chirurgie de la cataracte combinée avec des interventions chirurgicales de traitement du glaucome, vitréorétiniennes ou cornéennes et la survenue d’une (EPOA), de 2005 à 2014 en France. Méthodes : Les procédures de chirurgie de la cataracte par phacoémulsification et/ou de traitement du glaucome, vitréorétiniennes ou cornéennes ont été repérées par les codes correspondant de la classification commune des actes médicaux (CCAM) dans le programme de médicalisation des systèmes d’information (PMSI) du 1er janvier 2005 au 31 décembre 2014. L’EPOA était définie par la présence d’un diagnostic d’endophtalmie lors d’une h…
L’échantillon généraliste des bénéficiaires : un outil pour l’évaluation du risque vaccinal ?
Introduction Les bases de donnees medico-administratives sont de plus en plus utilisees pour evaluer le risque vaccinal. L’echantillon generaliste des beneficiaires (EGB) a ete cree a partir de celle de l’Assurance-maladie par echantillonnage au 1/97 e de la population francaise. L’objectif de l’etude est de calculer pour differentes associations effet indesirable/vaccin un nombre de cas necessaires et de comparer ces effectifs avec ceux disponibles dans l’EGB. Methodes L’analyse en serie de cas est une approche frequemment utilisee pour ce type d’etude. Les effectifs ont ete calcules dans ce cadre, avec et sans prise en compte de l’effet âge. Pour l’association convulsion febrile (CF)/vacc…
Accuracy of blood transfusion in postpartum hemorrhage to assess maternal morbidity.
International audience; OBJECTIVE: To measure the accuracy of blood transfusion (timing and number of blood units) in postpartum hemorrhage (PPH) in a perinatal network. STUDY DESIGN: (1) The ANONYMAT software system was used for anonymization and linkage of two large stand-alone databases, the Burgundy Perinatal Network (BPN) and the National Blood Centre (EFS) databases, which contain, respectively, clinical data from hospital discharges and information concerning any blood transfusion in France (considered as the gold standard database for identifying any transfusion). (2) Identification of prescriptions of at least one red blood cell (RBC) unit at the day of delivery (≥22 weeks) and up …
Évaluation de la qualité métrologique des données du Programme de médicalisation du système d’information (PMSI) en périnatalité. Étude pilote réalisée dans les CHU de Dijon, Port-Royal et Nancy
Introduction Le plan de perinatalite et les recommandations europeennes expriment la necessite de fournir des informations fiables indispensables a la realisation de travaux de recherche et a la production d’indicateurs nationaux. Parmi les multiples sources de donnees perinatales, les donnees du PMSI offrent la potentialite de fournir des informations systematiques et standardisees pour l’ensemble des naissances. L’objectif de l’etude etait de mesurer la faisabilite de valider la qualite metrologique des donnees du PMSI pour des indicateurs de base de sante perinatale dans trois centres hospitaliers universitaires pilotes, avant de mener une etude a l’echelon national. Methodes Dans trois …
Flexible modelling of the risks associated with donor sex and age of blood on survival after red blood cell transfusion
Etat de la question Les etudes realisees jusqu’a present en epidemiologie transfusionnelle affichent des resultats contradictoires sur l’association entre caracteristiques du CGR et la mortalite du patient receveur. La prise en compte des transfusions repetees de concentres de globules rouges (CGR) dans la survie est un domaine methodologiquement complexe, pouvant expliquer le manque de consensus scientifique. L’objectif de notre etude etait d’analyser l’impact du sexe du donneur et de la duree de conservation sur la survie par modele flexibles de type « Weighted Cumulative Exposure » (WCE) et de comparer les resultats au modele de Cox. Materiel et methodes Cette etude de survie a ete reali…
Multiple pregnancies and air pollution in moderately polluted cities: Is there an association between air pollution and fetal growth?
Background: Multiple pregnancies (where more than one fetus develops simultaneously in the womb) are systematically excluded from studies of the impact of air pollution on pregnancy outcomes. This study aims to analyze, in a population of multiple pregnancies, the relationship between fetal growth restriction (FGR), small for gestational age (SGA) and exposure to air pollution in moderately polluted cities. Methods: All women with multiple pregnancies living in the city of Besançon or in the urban area of Dijon and who delivered at a university hospital between 2005 and 2009 were included. FGR and SGA were obtained from medical records. Outdoor residential nitrogen dioxide (NO2) exposure wa…
Advantages and limitations of using national administrative data on obstetric blood transfusions to estimate the frequency of obstetric hemorrhages
International audience; BACKGROUND: Obstetric hemorrhages are a frequent cause of maternal death all over the world, but are not routinely monitored. Health systems administrative databases could be used for this purpose, but data quality needs to be assessed. OBJECTIVES: Using blood transfusion data recorded in administrative databases to estimate the frequency of obstetric hemorrhages. Research design A population-based study. Subjects Validation sub-sample: all mothers who gave birth in a French region in 2006-07 (35 123 pregnancies). Main study: all mothers who gave birth in France in 2006-07 (1 629 537 pregnancies). METHOD: Linkage and comparison of administrative data on blood transfu…
Évaluation de la qualité des données du programme de médicalisation des systèmes d’information pour la mesure de l’incidence hospitalière de l’accident vasculaire cérébral
Validation of the French national health insurance information system as a tool in vaccine safety assessment: Application to febrile convulsions after pediatric measles/mumps/rubella immunization
In the French national health insurance information system (SNIIR-AM), routine records of health claimed reimbursements are linked to hospital admissions for the whole French population. The main focus of this work is the usability of this system for vaccine safety assessment programme. Self-controlled case series analyses were performed using an exhaustive SNIIR-AM extraction of French children aged less than 3 years, to investigate the relationship between MMR immunization and children hospitalizations for febrile convulsions, a well-documented rare adverse event, over 2009-2010. The results suggest a significant increase of febrile convulsions during the 6-11 days period following any MM…
T080 - The incidence of rhegmatogenous retinal detachment in France from 2010 to 2016: seasonal and geographical variations
Évaluation de la qualité métrologique des données du programme de médicalisation du système d’information (PMSI) en périnatalité : étude pilote réalisée dans 3 CHU
Resume Position du probleme La France est l’un des derniers pays europeens a ne pas pouvoir fournir d’informations perinatales fiables, indispensables a la realisation de travaux de recherche et a la production d’indicateurs nationaux. Le systeme d’information perinatale en France est fragmente et les donnees, difficiles a regrouper, ne repondent pas aux exigences d’Europeristat. Les donnees du PMSI offrent la potentialite de fournir des informations systematiques et standardisees pour l’ensemble des naissances. L’objectif etait d’etudier la qualite metrologique des donnees du PMSI pour construire des indicateurs de base en sante perinatale dans trois centres hospitaliers universitaires, av…
Accessibilité de la maternité la plus proche en Bourgogne, comparaison de deux méthodes de calcul d’itinéraires
L’utilisation des antiTNFα pendant la grossesse augmente le risque de complications chez les femmes atteintes de maladies inflammatoires chroniques de l’intestin. Cohorte rétrospective sur le Système national d’information inter-régimes de l’assurance maladie (EVASION)
Introduction Les maladies inflammatoires chroniques intestinales (MICI) necessitent un traitement chronique, pouvant interferer avec le desir de grossesse chez les jeunes femmes. Une MICI non controlee en debut de grossesse est un facteur de mauvais pronostic maternel et fœtal. L’utilisation, hors autorisation, des antagonistes du « Tumor Necrosis Factor α » (anti-TNFα) durant la grossesse, augmente actuellement, et peuvent exposer la femme et le fœtus a des complications iatrogenes. Les recommandations actuelles sur les anti-TNFα dans cette population sont discordantes. Cette etude visait a evaluer, les modalites d’utilisation et le rapport benefice-risque des anti-TNFα pendant la grossess…
More than one in two venous thromboembolism treated in French hospitals occurs during the hospital stays
Objective The objective was to describe the prevalence of venous thromboembolism, pulmonary embolism, and deep vein thrombosis among hospitalized patients and the percentages of those occurring during the hospital stays. Methods French DRG gave now the opportunity to investigate the frequency of venous thromboembolism occurring during the hospital stay. Statistics are issued from the national PMSI MCO databases encoded using the CIM10. Since 2010–2011 it is possible to differentiate the reason for hospital admission from the pathologies which secondly occurred. Any stay with the ICD-10 codes selected was considered as a hospital-occurred thrombosis unless it was the principal diagnosis of t…
Impact of the COVID‐19 Epidemic on hospitalization for diabetic foot ulcers during lockdown: A French nationwide population‐based study
AIMS/HYPOTHESIS: The aim of this study was to examine the impact of the COVID-19 epidemic on the hospitalization rates for diabetic foot ulcer (DFU), osteomyelitis and lower limb revascularization procedure in people with DFU. METHODS: This nationwide retrospective cohort study included hospital data on all people hospitalized in France for diabetes in weeks 2-43 in 2020, including the COVID-19 lockdown period, compared to same period in 2019. RESULTS: The number of hospitalizations for DFU decreased significantly in weeks 12-19 (during the lockdown) (p < 10-4 ). Hospitalization for foot osteomyelitis also decreased significantly in weeks 12-19 (p < 10-4 ). The trend was the same for lower …
Hospitalization Within the First Year After Stroke
Background and Purpose— This population-based study aimed to identify unplanned hospitalization within the first year after stroke to determine factors associated with it and consequences on survival. Methods— All first-ever acute strokes occurring in Dijon, France, from 2009 to 2011, were prospectively collected from a population-based registry. Demographics and clinical data, including stroke severity measured by the National Institutes of Health Stroke Scale and disability after stroke, were recorded. For each patient, the first unplanned hospitalization that occurred within 1 year after stroke was retrieved by linking data with the national French Hospital Discharge Database. Predictor…
Stratification dépendante du temps dans la modélisation de Cox en tant que méthode de prise en compte d’interventions répétées dans la prise en charge des patients : l’exemple de la transfusion de sang
International audience; IntroductionLa transfusion de concentrés de globules rouges (CGR) est le traitement symptomatique de l’anémie et contribue à l’oxygénation des tissus au cours de pathologies sévères. Nous menons une recherche sur l’effet des caractéristiques des CGRs sur la survie des patients dans les CHU de Besançon et Dijon : l’étude STeF-BFC. Nous étudions l’effet de la durée de conservation (DC) et du sexe du donneur (SD) des CGR sur la survie à un an de patients de chirurgie cardiovasculaire. Dans ce type d’étude, le nombre de CGR reçus est un facteur de confusion majeur. Il s’agit d’un biais d’indication mais aussi un biais de survivant (il faut avoir survécu jusqu’à la transf…
Does low to moderate environmental exposure to noise and air pollution influence preterm delivery in medium-sized cities?
International audience; Background: Preterm birth (PB) is an important predictor of childhood morbidity and educational performance. Beyond the known risk factors, environmental factors, such as air pollution and noise, have been implicated in PB. In urban areas, these pollutants coexist. Very few studies have examined the effects of multi-exposure on the pregnancy duration. The objective of this study was to analyse the relationship between PB and environmental chronic multi-exposure to noise and air pollution in medium-sized cities.Methods: A case-control study was conducted among women living in the city of Besançon (121 671 inhabitants) or in the urban unit of Dijon (243 936 inhabitants…
Use of drug treatments for Alzheimer's disease in France: a study on a national level based on the National Alzheimer's Data Bank (Banque Nationale Alzheimer)
Purpose To examine the way in which specific drug treatments for Alzheimer's disease are used and whether their use complies with clinical practice guidelines issued by the French National Authority for Health in patients with Alzheimer's disease. Methods We analysed a cross-section of the French National Alzheimer's databank (BNA). Participants were individuals who consulted centres contributing to the BNA in 2010 and diagnosed with Alzheimer's disease and with at least one Mini Mental State Examination (MMSE) score recorded during the course of the year. Results Of 191 919 consultations recorded in the database, 29.9% involved a diagnosis of Alzheimer's disease, and 26 809 patients had co…
Epidemiology of acute endophthalmitis after ophthalmological procedures, a national database description
International audience; Purpose : Although rare, endophthalmitis is a severe complication of ophthalmological procedures. The incidence of endophthalmitis following cataract, glaucoma, vitreoretinal surgeries, and intravitreal injections has previously been described in large-scale studies, but no data is available on the proportion of causative procedures. We aimed to describe longitudinally the causes of endophthalmitis at a national scale using the French medico-administrative database.Methods : The SNIIRAM (French national inter-scheme insurance database) collects all data of medical expenditures and procedures performed in France. We extracted acute endophthalmitis occurring 42 days af…
Effect of storage time and donor sex of transfused red blood cells on 1-year survival in patients undergoing cardiac surgery: an observational study
BACKGROUND Red blood cell (RBC) storage lesions and RBCs from females transfused into male recipients may have adverse effects on transfusion recipients' survival. We hypothesized that the effect of donor sex and the effect of age of blood on mortality would be most apparent in cardiac surgery patients. STUDY DESIGN AND METHODS Using data from French Blood Services and two university hospitals, we conducted a retrospective cohort study on cardiac surgery patients whose first transfusion occurred between 2007 and 2011. The age of blood and donor sex effects on 1-year survival were studied using Cox regression modeling, with time-dependent stratification on the number of RBCs and adjustments …
Comparative Analysis of Patients with Acute Coronary and Cerebrovascular Syndromes from the National French Hospitalization Health Care System Database
<i>Background:</i> Nationwide evaluations of the epidemiology of acute coronary syndrome (ACS) or cerebrovascular syndrome (CVS) are scarce. We aimed to analyze nationwide French data on patients referred to hospital for either ACS or CVS. <i>Methods:</i> Using the French national hospital discharge diagnosis records, all patients hospitalized between 2005 and 2008 with a diagnosis of ACS and CVS based on the ICD-10 were identified. We analyzed vascular risk factors and early outcomes in patients with a single hospitalization for ACS or CVS or for both ACV and CVS in a 2-month time window. <i>Results:</i> 1,187,643 patients were recorded. Among these, 638…
Est-il possible de construire un indicateur de morbidité maternelle sévère (hémorragie maternelle) à partir des données du programme de médicalisation des systèmes d’information complétées par celles de l’Établissement français du sang ?
Antibiotic prophylaxis and intravitreal injections: impact on the incidence of acute endophthalmitis
International audience
Customized and non-customized live-born birth-weight curves of single and uncomplicated pregnancies from the Burgundy perinatal network. Part I – methodology
International audience; Objectives: To establish non-customized and customized birth-weight curves of single and uncomplicated pregnancies according to gestational age.Materials and methods: We used data for 64,173 mother-infants pairs from the Burgundy perinatal network database (France) over the period 2005-2013. A validated procedure was used to link mothers with their newborns, and maternal and fetal pathologies likely to affect birth weight were excluded. Multiple regression analysis with covariate selection was used to build a customized growth curve with maternal and fetal parameters.Results: Using this methodology, three different curves were generated: an unadjusted curve for birth…
Outcomes after acute myocardial infarction in HIV-infected patients: analysis of data from a French nationwide hospital medical information database.
Background— We aimed to assess in-hospital case fatality and 1-year prognosis in HIV-infected patients with acute myocardial infarction. Methods and Results— From the PMSI (Program de Medicalisation des Systèmes d’informatique) database, data from 277 303 consecutive acute myocardial infarction patients hospitalized from January 1, 2005, to December 31, 2009, were analyzed. Surviving patients were followed up for 1 year after discharge. HIV-infected patients were compared with uninfected patients. Among the cohort, HIV-infected patients (n=608) accounted for 0.22%. All-cause hospital and 1-year mortality rates were lower in the HIV-infected group than in uninfected patients (3.1% versus 8.…
Risque de maladie thromboembolique veineuse dans l’année qui suit le diagnostic de cancer du poumon en France
Etat de la question La maladie thromboembolique veineuse (MTEV) comprend la thrombose veineuse profonde (TVP) et sa principale complication l’embolie pulmonaire (EP). La MTEV est une pathologie frequente chez les patients atteints de cancer et est responsable d’une morbi-mortalite importante. L’objectif de notre etude etait d’estimer la frequence de la MTEV chez les patients atteints d’un cancer du poumon en France et d’en identifier des facteurs de risque. Materiel et methodes Les donnees ont ete extraites de la base de donnees de l’echantillon generaliste des beneficiaires (EGB), qui est un echantillon permanent des donnees de l’Assurance maladie francaise (incluant des donnees d’hospital…
Validation des hémorragies maternelles codées dans le programme de médicalisation des systèmes d’information (PMSI) par couplage aux données de l’Établissement français du sang (EFS)
L'administration conjointe du dossier patient: une responsabilité partagée entre le patient et le praticien
National audience; The main problem faced by patients, health practitioners and the authorities, is namely the gathering and updating of administrative and medical data in order to accurately reconstitute a patient's medical history. Although solutions to accelerate and to ease this gathering are being implemented at the national level in several European countries, as unique health identifier in France, information still have to be validated before use. Through this article, we propose a mixed management of patients' data, split between the patient regarding administrative information and the Medical Practitioner (MP) regarding medical information. This method is based on two processes. Th…
Incidence de l’endophtalmie aiguë postopératoire après chirurgie de la cataracte par phacoémulsification et injection intracamérulaire d’antibiotiques, en France de 2005 à 2014
National audience; Introduction La chirurgie de la cataracte est l’intervention la plus fréquente dans le monde. Parmi ses complications, l’endophtalmie aiguë postopératoire (EAPO) est une infection intraoculaire sévère, qui peut conduire à la cécité. Les objectifs étaient de déterminer l’incidence de l’EAPO après chirurgie de la cataracte par phacoémulsification en France de 2005 à 2014 et d’analyser l’association entre injection intracamérulaire d’antibiotique (IICA) et EAPO. Méthodes Tous les patients hospitalisés pour une chirurgie de la cataracte en France entre le 1er janvier 2005 et le 31 décembre 2014 ont été identifiés dans le programme de médicalisation des systèmes d’information …
Estimation of National Colorectal-Cancer Incidence Using Claims Databases
Background.The aim of the study was to assess the accuracy of the colorectal-cancer incidence estimated from administrative data.Methods.We selected potential incident colorectal-cancer cases in 2004-2005 French administrative data, using two alternative algorithms. The first was based only on diagnostic and procedure codes, whereas the second considered the past history of the patient. Results of both methods were assessed against two corresponding local cancer registries, acting as “gold standards.” We then constructed a multivariable regression model to estimate the corrected total number of incident colorectal-cancer cases from the whole national administrative database.Results.The firs…
Positive Predictive Value of French Hospitalization Discharge Codes for Stroke and Transient Ischemic Attack.
<b><i>Background:</i></b> We aimed at measuring the positive predictive value (PPV) of data in the French Hospital Medical Information Database (FHD). <b><i>Summary:</i></b> This retrospective multicenter study included 31 hospitals from where 56 hospital stays were randomly selected among all hospitalizations for the years 2009 and 2010 with at least 1 principal diagnosis of stroke or transient ischemic attack (TIA). Three algorithms were evaluated. Algorithm 1 selected discharge abstracts with at least 1 principal diagnosis identified by one of the relevant International Classification of Diseases, 10th revision codes. Algorithm 2 selected s…
270 Increased hospital mortality in HIV-infected patients with acute coronary or cerebrovascular syndromes. Analysis from a French nationwide hospital medical information database
Background After more than two decades of the AIDS epidemic, the spectrum of HIV-associated vascular diseases has considerably evolved from infectious disease with improved survival, to premature atherosclerosis. As a consequence, acute atherosclerosis complications, such as acute coronary and cerebrovascular syndromes (ACS and CVS) are currently growing. However, only few data are available on HIV-infected patients in the setting of ACS/CVS. The aim of the present study was to determine the prevalence of HIV, as well as the characteristics and hospital case fatality of HIV-infected patients with CVS and ACS. Methods From the French nationwide hospital medical information database, data fro…
Incidence de l’endophtalmie postopératoire aiguë après chirurgie maculaire en France entre 2006 et 2016
Etat de la question L’objectif de cette etude nationale etait de rapporter l’incidence de l’endophtalmie postoperatoire aigue (EPOA) apres chirurgie maculaire en France entre 2006 et 2016 et d’identifier si le passage a la vitrectomie transconjonctivale en 2010–2011 etait associe a une modification du risque d’EPOA en France. Materiel et methodes Toutes les interventions chirurgicales pour membrane epiretinienne ou trou maculaire realisees en France entre janvier 2006 et octobre 2016 ont ete incluses a partir du PMSI. L’EPOA etait identifiee dans les 42 jours apres la chirurgie maculaire. Les effets du changement de technique (periode), des facteurs demographiques et cliniques sur la surven…
274 Comparative analysis of patients with acute coronary and cerebrovascular syndromes from the national French hospitalisation heath care system database
Objective To compare vascular risk factor profiles and early outcomes in all French patients hospitalized for either acute coronary (ACS), or cerebrovascular syndromes (CVS), or both, between 2005 and 2008. Setting All French hospitals. Design Retrospective analysis. Data sources National database called “Hospital Discharge Diagnosis Records”. Main outcomes measured Number and annual rates, vascular risk factors, and early outcome of hospitalized patients for a unique stay for ACS or CVS or for both ACV and CVS in a 2-month time window. Results Over the 4-year study-period, 1,189,043 patients were hospitalized for CVS and/or ACS. Among these, 638,061 (53.7%) had CVS alone, 525,419 (44.3%) h…
Exposition environnementale au bruit et à la pollution de l'air au cours de la grossesse avec comorbidités associées
L’objectif était d’analyser le lien entre l’exposition environnementale au bruit et à la pollution de l’air en milieu urbain et la prématurité chez les femmes dont le risque d’accouchement prématuré était augmenté par la présence d’une ou plusieurs comorbidités. Méthode. Une étude cas-témoins a été conduite sur les grossesses uniques accompagnées d’au moins une comorbidité. Les accouchements ont eu au CHU de Besançon ou de Dijon entre 2005 et 2009. Le niveau sonore de nuit (Lnight en façade du bâtiment d’habitation) et la concentration en dioxyde d’azote (NO2) dans les 50 m autour de l’habitation ont été modélisés à l’adresse déclarée au moment de l’accouchement. Une régression logistique c…
225 Comparative analysis of patients with acute coronary and cerebrovascular syndromes from the national French hospitalisation heath care system database
ObjectiveTo compare vascular risk factor profiles and early outcomes in all French patients hospitalized for either acute coronary (ACS), or cerebrovascular syndromes (CVS), or both, between 2005 and 2008.SettingAll French hospitals.DesignRetrospective analysis.Data sourcesNational database called “Hospital Discharge Diagnosis Records”.Main outcomes measuredNumber and annual rates, vascular risk factors, and early outcome of hospitalized patients for a unique stay for ACS or CVS or for both ACV and CVS in a 2-month time window.ResultsOver the 4-year study-period, 1,189,043 patients were hospitalized for CVS and/or ACS. Among these, 638,061 (53.7%) had CVS alone, 525,419 (44.3%) had ACS alon…