Permanent study on home and leisure injuries

July 2006
Permanent study on
home and leisure injuries
Epac network
Results 2004
Contents
1 Overview
p.
1
2 Results
p.
2
2.1 | Injured patients
p. 2
2.2 | Place of occurence of HLIs
p. 3
2.3 | Activity
p. 4
2.4 | Mechanism
p. 5
2.5 | Injury
p. 6
2.6 | Part of body injured
p. 8
2.7 | Care, reatment, hospitalisation
p. 9
1
Overview
Home and leisure injuries (HLIs) are unintentional injuries.
They include:
In 2004, nine hospitals contributed to the database,
entering a total of 88,707 records:
• domestic injuries, taking place at home or in its
immediate surroundings: garden, courtyard, garage,
and other outbuildings;
• Annecy general hospital (17% of records);
• injuries that occur outside: in a shop, on a pavement,
near the home, etc.;
• school injuries, including injuries suffered on the way to
or from school, during physical education classes and
on school grounds;
• sports injuries;
• holiday and leisure injuries.
Home and leisure injuries are very common: millions of
HLIs requiring medical treatment occur in France every
year. There are very few sources of epidemiological
information in this area. The French permanent study
on home and leisure injuries, Enquête permanente sur
les accidents de la vie courante (Epac), is operational
in a number of volunteer hospitals in France. Epac is
part of the European Injury Data Base (IDB) system, in
which emergency departments register in the database
information on patients treated for an HLI: age, sex, place
of residency, care provided (date and time of emergency
department admission, treatment, hospitalisation if
applicable), details of the accident (mechanism, place,
activity, nature of injury, part of body injured), and
products (agents, elements) that caused or were involved
in the injury. Finally, a short description of the accident is
entered as free-form text.
• Besançon teaching hospital (8%);
• Béthune hospital (9%);
• Bordeaux teaching hospital (15%);
• Le Havre hospital group (19%);
• Cochin hospital in Paris (6%);
• Saint-Paul hospital on la Réunion (3%) ;
• Vannes hospital (19%);
• Franciscan clinic in Versailles (4%).
The results of the Epac study from recent years have
been used on many individual occasions, and have been
covered in two recently published reports:
• Résultats de l’Enquête permanente sur les accidents
de la vie courante, années 1999-2001. Réseau Epac.
Institut de veille sanitaire, décembre 2003 ;
• Résultats de l’Enquête permanente sur les accidents
de la vie courante, années 2002-2003. Réseau Epac.
Institut de veille sanitaire, octobre 2005.
Since 1999, the results have proved robust at the level
of detail used to report them. The distributions by age,
sex, place, activity, mechanism, injury and part of body
injured do not show variation over time. This level of
stability in the results has been observed despite the
change in the number and type of hospitals in the
network and the change of nomenclature on 1 January
2004. The new nomenclature and the rules for data
collection are described in the Epac reference guide,
Guide de référence de l’Enquête permanente sur les
accidents de la vie courante, published by the InVS in
December 2004.
These results can be consulted on the section of the InVS website dedicated to home and leisure injuries: www.invs.sante.fr, “Dossiers thématiques”, “Accidents de la vie
courante”.
These results may be cited or distributed with the following reference:
Thélot B, Ricard C. Results of the permanent study on home and leisure injuries, 2004. Epac network. Institut de veille sanitaire, July 2006.
Permanent study on home and leisure injuries
Epac network - Results 2004
2
Results
2.1 | Injured patients
Distribution of HLIs according to age and sex
Age (y)
Male
Female
n
%
n
0–4
8,346
17%
6,235
5–9 6,534
14%
10–14 8,133
15–19 n
%
Sex-ratio
17%
14,581
17%
1.34
4,828
13%
11,362
13%
1.35
17%
6,080
16%
14,213
17%
1.34
4,521
9%
2,514
7%
7,035
8%
1.8
20–24 3,804
8%
1,952
5%
5,756
7%
1.95
25–29 2,936
6%
1,511
4%
4,447
5%
1.94
30–34 2,610
5%
1,401
4%
4,011
5%
1.86
35–39 2,099
4%
1,241
3%
3,340
4%
1.69
40–44 1,836
4%
1,229
3%
3,065
4%
1.49
45–49 1,484
3%
1,128
3%
2,612
3%
1.32
50–54 1,253
3%
1,237
3%
2,490
3%
1.01
55–59 1,151
2%
1,194
3%
2,345
3%
0.96
60–64 732
2%
857
2%
1,589
2%
0.85
65–69 601
1%
878
2%
1,479
2%
0.68
70–74 538
1%
1,033
3%
1,571
2%
0.52
≥ 75 1,446
3%
4,432
12%
5,878
7%
0.33
Total
48,024
100%
37,750
100%
85,774
100%
1.27
Of the 88,707 injuries registered in the Epac database
in 2004, the age and sex of the patient were entered in
the vast majority of cases (85,774 HLIs). The data in the
Epac database for 2004 show that, in the hospitals in the
network, the number of patients injured according to age
range decreases from birth to approximately 70 years
of age, and increase from this age onwards. There is a
markedly higher number of male HLI patients up to the
Total
Permanent study on home and leisure injuries
Epac network - Results 2004
%
age of 50, resulting in sex ratio values between 1.3 and
2.0. After 65 years of age there is a greater proportion
of injured women than men, principally because they
are over-represented in the general population (general
population sex ratio 0.69 after 65 years of age), but also
because they suffer more falls than men.
Results
2
2.2 | Place of occurrence of HLIs
Distribution of HLIs according
to place of occurrence
Transport/
pedestrian area
11%
Sports/
games area
19%
Home
50%
Place of injury according to age,
males
Place of injury according to age,
females
80%
80%
60%
60%
40%
40%
20%
20%
0%
0%
Transport/pedestrian area
School/public place
There is an uneven distribution of places of occurrence
of injuries according to age for males and females:
• the home is the most common place of occurrence of
HLIs for females (55% of HLIs compared to 47% for
males). More than half of injuries occur at home from
the age of 20 onwards. This proportion increases with
age, accounting for more than two in three HLIs in
people aged 75 and above;
4y
0-
9y
10
4y
0-
5-
Home
Sports/games area
Other
ea
rs
e
10
ars
-1
4y
ea
15
rs
-1
9y
e
20
ars
-2
4
25 yea
r
-2
9y s
ea
30
rs
-3
4y
ea
35
rs
-3
9y
ea
40
rs
-4
4y
ea
45
rs
-4
9y
ea
50
rs
-5
4y
ea
55
rs
-5
9y
ea
60
rs
-6
4y
ea
65
rs
-6
9y
ea
70
r
s
-7
4y
ea
�
rs
75
ye
ars
100%
ea
rs
ea
rs
-1
4y
ea
15
rs
-1
9y
ea
20
rs
-2
4
25 yea
rs
-2
9
30 year
s
-3
4y
ea
35
rs
-3
9
40 year
s
-4
4y
ea
45
r
s
-4
9y
ea
50
rs
-5
4y
ea
55
rs
-5
9y
ea
60
rs
-6
4y
ea
65
r
s
-6
9y
ea
70
rs
-7
4y
ea
�
rs
75
ye
ars
100%
9y
School or
public place
12%
5-
Other
8%
Half of HLIs occur in the home or its surroundings. Other
common places of occurrence are sports and games
areas (19%), public places and schools (12%) and
transport and pedestrian areas (public highway, train
station, pavement, etc., 11%). The remaining places,
in which 8% of HLIs take place, are shops, farming or
industrial areas, the countryside, etc.
Home
Sports/games area
Other
Transport/pedestrian area
School/public place
• in males, more injuries occur in sports and games
areas (22%, compared with 14% for females). Injuries
in sports and games areas occur most frequently
between the ages of 15 and 40 years (45 to 15%).
Permanent study on home and leisure injuries
Epac network - Results 2004
2
Results
2.3 | Activity
Distribution of HLIs according to activity
Domestic
activity
7%
DIY
4%
Other (incl.
Walking)
23%
Personal
needs
6%
Games and leisure are the activities most commonly
being practised when HLIs occur (38%), in both males
(40%) and females (36%). Other activities, in particular
walking, are responsible for 23% of HLIs, followed by
sports (22%), domestic activities (7%), personal needs
(washing, eating, sleeping, etc., 6%) and DIY (Do It
Yourself, 4%).
Games/
leisure
38%
Sports
22%
60%
40%
40%
20%
20%
0%
0%
The distribution of activities being practised when the
HLI occurred varies significantly according to age and
sex:
• the incidence of HLIs connected with personal needs
increases with age;
• games and leisure HLIs occur very frequently in early
childhood (more than one in three HLIs) then the
incidence decreases from this point onwards, although
Permanent study on home and leisure injuries
Epac network - Results 2004
4y
-3
-3
30
Domestic activity
Games/leisure
DIY
35
4y
9y
-2
-2
20
25
4y
15
-1
9y
rs
-1
ea
ea
9y
10
4y
0-
-2
-3
30
Personal activity
Sports
Other (incl. Walking)
5-
rs
rs
ea
25
-2
4y
ea
20
15
-1
9y
4y
ea
rs
-1
ea
ea
10
4y
9y
0-
5-
Domestic activity
Games/leisure
DIY
ea
rs
9y
ea
40
rs
-4
4y
ea
45
rs
-4
9y
ea
50
rs
-5
4y
ea
55
r
s
-5
9y
ea
60
rs
-6
4y
ea
65
rs
-6
9y
ea
70
rs
-7
4y
ea
�
rs
75
ye
ars
60%
ea
rs
ea
rs
80%
ea
rs
ea
rs
80%
rs
100%
9y
ea
rs
4y
e
35
ars
-3
9
40 year
s
-4
4y
ea
45
rs
-4
9y
ea
50
rs
-5
4y
ea
55
rs
-5
9y
ea
60
rs
-6
4y
ea
65
r
s
-6
9y
ea
70
rs
-7
4y
ea
�
rs
75
ye
ars
100%
rs
Activity according to age, females
rs
Activity according to age, males
Personal activity
Sports
Other (incl. Walking)
games and leisure activities remain a common cause
of HLIs;
• sports-related injuries represent more than one in
three HLIs between the ages of 10 and 24: 44 to 51%
in males, and 39 to 20% in females;
• from 30 years of age onwards, HLIs are often connected
with domestic activities: DIY predominantly in males
(more than one in five HLIs) and other domestic activities
particularly in females (almost one in four HLIs).
Results
Sport being practised when
the injury occurred
Water
sports
3%
Other
3%
Winter
sports
10%
Sports with
animals
4%
2
In 2004, the sport being practised when the injury
occurred was entered in 16,824 cases. Almost half
(43%) were team sports, notably football (62% of
team sports). Sports involving a non-motor vehicle
Athletics
were being practised in 21% of HLIs, 73% of which
4%
involved bicycles. Winter sports were the cause of 10%
Gymnastics
4%
of HLIs. The fourth most common type of sport being
Racket sports practised was combat sports (5%), followed by athletics,
3%
gymnastics, sports involving animals (4% each), racket
sports (such as tennis or badminton), water sports and
other sports (3% each).
Team sports
43%
Wheeled nonmotor vehicle
21%
The majority of people practising a sport when they
suffered their injury were aged between 5 and 29 years
(79%). The 10 to 14 age group alone included 30% of
the injured people.
Most sports injuries were suffered by males (70%, sexratio 2.3).
Combat
sports
5%
2.4 | Mechanism
Distribution of HLIs according
to mechanism
Other
4%
Foreigner
body
3%
The most common HLI mechanism was a fall (60%),
followed by blows (18%), cuts, compression and
perforations (11%). Overexertion, including inadvertent
movements, was the source of 4% of HLIs, while foreign
bodies (e.g. in the eye, nose, etc.) accounted for 3%.
Other HLI mechanisms (4%) were burns, poisoning or
asphyxia (with no foreign body involved). This distribution
of mechanisms was the same in males as in females.
Overexertion
4%
Compression,
cut, perforation
11%
Blow
18%
Fall
60%
Permanent study on home and leisure injuries
Epac network - Results 2004
2
Results
Distribution of mechanisms according to age
100%
80%
60%
Other
Compression, cut, perforation
Foreigner body
Overexertion
Blow
Fall
40%
20%
04y
ea
59 y rs
ea
10
r
-1
4y s
15
-1 ears
9
20 yea
-2
4 y rs
25
ea
rs
-2
9
30 yea
-3
r
s
4
35 yea
-3
r
s
9
40 yea
r
-4
4y s
45
ea
-4
rs
50 9 y
-5 ea
4 y rs
55
-5 ears
60 9 ye
-6
4 ars
65 yea
rs
-6
9
70 ye
ars
-7
4y
�
75 ears
ye
ars
0%
Falls represented the most common mechanism of
injury in patients of all ages. Falls caused more than one
in two HLIs in those under 15 or over 40 years of age,
and were the primary cause of HLIs in the very elderly
(90% of HLIs in people aged 75 and over). Blows
accounted for more than one in five HLIs in people
younger than 30, while cuts were most common in adults
aged between 20 and 60 (15 to 19% of HLIs).
2.5 | Injury
The vast majority of HLIs resulted in only one injury, with
a second injury being registered in the Epac database
in only 8% of cases, and a third injury in less than 1%
of cases. The information that follows relates to the main
injury.
Distribution of HLIs according to injury
Contusions represented the most common type of injury
after an HLI (30% of injuries), followed by wounds (24%),
fractures (17%), sprains (10%) and finally concussion
(5%). The other types of injury (11%) were burns,
poisoning, abrasions, dislocations, etc.
Other
11%
Concussion
5%
Sprain
13%
Contusion
30%
Fracture
17%
Wound
24%
Permanent study on home and leisure injuries
Epac network - Results 2004
There was no difference between males and females in
the distribution of injuries. The proportion of males was
greater whatever the injury. The over‑representation of
males was very marked for wounds (sex-ratio 1.8) but
much lower for fractures and sprains (sex-ratio 1.1).
Results
2
Distribution of injuries according to age
100%
80%
60%
Other
Sprain
Fracture
Wound
Contusion
Concussion
40%
20%
04
59
ye
ars
ye
10
ars
-1
4y
ea
15
rs
-1
9y
e
20
ars
-2
4
25 yea
r
-2
9y s
ea
30
rs
-3
4y
ea
35
rs
-3
9
40 year
s
-4
4y
ea
45
r
s
-4
9y
ea
50
r
s
-5
4y
ea
55
rs
-5
9y
ea
60
rs
-6
4y
ea
65
rs
-6
9y
ea
70
rs
-7
4y
ea
�
r
s
75
ye
ars
0%
The incidence of contusions, common in children and
young adults (approximately 31 to 37% of injuries in
patients under the age of 20), decreased with age,
accounting for only one in five HLIs in patients older than
45 years of age.
Fractures were not common in very young patients
(8% of injuries in children under 5), but the proportion of
fractures increased in older patients to account for 39%
of injuries from the age of 75 onwards.
Sprains occurred most commonly in patients aged
between 10 and 25 (between 19 and 25% of injuries).
Wounds represented 34% of injuries in those under the
age of 5, were less common in patients aged between
10 and 20 (one in six injuries), and represented only one
quarter of injuries in people aged over 20.
Distribution of injuries according to activity
19%
20%
7%
3%
11%
11%
7%
9%
8%
10%
17%
44%
16%
15%
5%
6%
Domestic
Activity
DIY
Concussion
9%
33%
38%
5%
3%
Games/
leisure
Contusion
Wounds were the most common injury in all activities
except sports and walking. For these activities,
contusions occurred more frequently than other injuries
(38% and 32%, respectively). Sprains, reported in more
14%
6%
17%
13%
16%
27%
42%
26%
27%
26%
24%
24%
32%
7%
3%
Sports
Wound
Fracture
Personal
activity
Sprain
Other
(incl. Walking)
Other
than one quarter of sports accidents, were not common
in other activities.
Permanent study on home and leisure injuries
Epac network - Results 2004
2
Results
2.6 | Part of body injured
Distribution of HLIs according
to part of body injured
The limbs were the part of the body most commonly
affected in HLIs: 36% of injuries were to the upper limbs
and 30% to the lower limbs. The third most common
type of injury was head injuries (26%) followed by
injuries to the torso, which occurred less frequently (7%).
The other parts of the body (whole body or a number
of parts of the body affected) accounted for only 1% of
HLIs.
Other
1%
Lower
limbs
30%
Head
26%
The distribution of injured parts of the body was the same
in males as in females. There was a greater proportion of
males in every category, with a more marked difference
for the head (sex-ratio 1.6) than for the upper limbs
(sex-ratio 1.3), lower limbs or torso (sex-ratio 1.1).
Torso
7%
Upper
limbs
36%
Distribution of parts of body injured
according to age
In young children, the part of the body most often
injured was the head (58% of HLIs in children under
5). This proportion decreased up to 10 years of age,
then increased slightly up to the age of 75 (from 13% in
10- to 14-year-olds to 26% in patients over 75).
In teenagers and adults, there was little variation in the
distribution of parts of the body injured. The incidence of
injuries to the torso increased with age, from 4% of the
parts of the body injured between 0 and 4 years of age
to 12% in patients aged 75 or over.
100%
80%
60%
40%
20%
Head
ea
rs
9y
ea
rs
-4
4y
ea
45
rs
-4
9y
ea
50
rs
-5
4y
ea
55
rs
-5
9y
ea
60
rs
-6
4y
ea
65
r
s
-6
9y
ea
70
rs
-7
4y
ea
�
rs
75
ye
ars
Torso
40
4y
-3
35
-3
ea
rs
ea
rs
30
4y
-2
-2
25
20
9y
ea
rs
ea
rs
4y
9y
-1
-1
15
10
4y
0-
5-
9y
ea
rs
ea
rs
0%
Lower limbs
Upper limbs
Other
Distribution of injuries according to part
of body injured
7%
3%
8%
11%
22%
10%
3%
32%
16%
49%
54%
27%
5%
18%
2%
22%
11%
42%
19%
32%
12%
9%
Head
Concussion
27%
30%
2%
2%
Torso
Contusion
Upper
limbs
Wound
Lower
limbs
Fracture
Permanent study on home and leisure injuries
Epac network - Results 2004
21%
4%
Other
Sprain
Other
Contusions were the most frequent injuries, with
proportions varying according to the part of the body
injured: 27% of the HLIs affected the upper limbs, 30%
the lower limbs, 32% the head and 42% the torso. In
addition to contusions, fractures and wounds were
common injuries to the upper limbs (27% and 22%,
respectively), while the lower limbs most frequently
suffered sprains (32%). The injuries to the head were
wounds in almost half of cases (49%).
Results
2
2.7 | Care, treatment, hospitalisation
In more than half (53%) of HLIs, no treatment was
provided or the patient was discharged immediately after
treatment. In 37% of HLIs, treatment was provided along
with follow-up care, either by a community doctor or by
the hospital, while in 11% of cases hospitalisation was
required.
Distribution of type of care provided
according to age
The hospitalisation rate increased significantly with
age from 50 years of age, standing at 7% for injured
patients under 5 and only 4% for patients between 15
and 24 years of age, and increasing to 37% for injured
patients aged 75 or over. The proportion of patients
receiving treatment plus follow-up care was higher in
patients between 0 and 29 years of age, increasing from
26% to 46% of HLIs, with a frequency decreasing to
29% in patients aged over 75. The percentage of injured
patients who were only examined and treated decreased
with age, varying from 67% in children to 34% in elderly
people.
100%
80%
60%
40%
20%
ea
rs
4y
ea
45
rs
-4
9y
ea
50
rs
-5
4y
ea
55
rs
-5
9y
ea
60
rs
-6
4y
ea
65
r
s
-6
9y
ea
70
rs
-7
4y
ea
�
rs
75
ye
ars
9y
-4
40
rs
rs
ea
4y
-3
-3
30
35
rs
ea
ea
4y
-2
-2
25
20
9y
rs
rs
ea
ea
4y
-1
15
-1
9y
rs
ea
10
9y
5-
0-
4y
ea
rs
0%
Examided, treated
Follow-up
Hospitalised
Number of days of hospitalisation
(8,274 patients hospitalised)
> 25 d
21-25 d
16-20 d
4.6%
2.5%
4.4%
11-15 d
8.8%
6-10 d
5d
4d
3d
2d
10.4%
3.7%
4.7%
5.9%
For the 8,274 patients hospitalised, the mean duration of
hospitalisation was 5.2 days and the median 2.0 days.
This is because there was a large number of very short
hospital stays and a small number of long hospital
stays.
Mean duration : 6.1
Median duration : 2d
Percentiles 30 : 1d
40 : 1d
50 : 2d
60 : 3d
70 : 6d
80 : 11d
90 : 17d
13.9%
0-1 d
41.2%
Mean duration of hospitalisation (in days)
according to age and sex
14
Males
12
The mean duration of hospitalisation increased with age:
from 2 days for patients aged 0-4 years, it increased to
12 days in patients older than 75. It was significantly
longer for females (7.6 days) than for males (4.7 days).
Females
10
8
6
4
2
4y
ea
15
rs
-1
9y
ea
20
rs
-2
4
25 yea
rs
-2
9
30 year
s
-3
4y
ea
35
rs
-3
9
40 year
s
-4
4y
ea
45
rs
-4
9y
ea
50
rs
-5
4y
ea
55
rs
-5
9y
ea
60
rs
-6
4y
ea
65
rs
-6
9y
ea
70
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Permanent study on home and leisure injuries
Epac network - Results 2004
9
Surveillance
ISBN : 2-11-096377-8
Tirage : 350 exemplaires
Dépôt légal : Juillet 2006
Réalisation : Labrador
Impression : France Repro - Maisons-Alfort
Département des maladies chroniques et des traumatismes
12, rue du Val d’Osne - 94415 Saint-Maurice cedex
Tél. : 33(0) 1 41 79 67 00 - Fax : 33(0) 1 41 79 67 67
http://www.invs.sante.fr