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Road traffic accidents in France: an epidemiological overview of severe trauma from 2010 to 2024, from the Traumabase registry
Position du problème et objectif(s) de l’étude
Road traffic accidents (RTA) are one of the leading causes of severe trauma worldwide. In France, over the last 10 years, RTA-related morbidity and mortality have stabilized, with approximately 3 500 deaths and 250 000 injuries annually despite strong enforcement of road safety laws. Objective: To provide a comprehensive overview of RTA epidemiology, injury patterns, and ICU-related mortality in France over 14 years, using data from the Traumabase® registry.
Matériel et méthodes
We included all patients aged >15 years referred for suspected severe trauma following an RTA and recorded in the Traumabase® registry between November 1st, 2010, and December 31st, 2024. We described patients’ characteristics and injury patterns. Traumatic Brain Injury (TBI) was defined as head AIS ≥1. Severe injury was defined as an Abbreviated Injury Scale (AIS) ≥3 for the related anatomical region. Severe bleeding was defined as requiring ≥4 blood units within 6 hours of trauma bay admission. Patients were compared according to injury mechanism: motor vehicles, motorised 2-wheel vehicles, E-scooters, bicycles, and pedestrians, using Kruskal-Wallis or Chi-squared tests. Thirty-day ICU mortality was analysed via the Kalbfleisch and Prentice method, considering ICU discharge as a competing event.
Résultats & Discussion
A total of 27 280 patients were analysed, mostly men (77%), median age 34 years (IQR 24–51), with 72% being ASA-PS 1. Mechanisms involved were mainly motor vehicles (38%) and motorised 2-wheel vehicles (39%), followed by pedestrians (14%), bicycles (7%), and E-scooters (2%). There were 2 217 ICU deaths over the study period, predominantly in the extreme age groups. Fatalities involved mainly motor vehicles and motorised 2-wheel vehicles among those aged 15–25 years, and motor vehicles and pedestrians among those >75 years (figure 1) Pedestrians were older (median 48 years, IQR 29–67) and more likely to have ASA-PS >1 (43% vs. 20-32%). TBI was more frequent in bicycles, E-scooters, and pedestrians (61–63%) vs. 35% in motorised 2-wheel vehicles and 45% in motor vehicles. Severe bleeding was more frequent in pedestrians (9.4%) than others (2.1% in E-scooters to 6.7% in motor vehicles). Bicycles and pedestrians had higher Injury Severity Scores (51% and 54% of ISS >16) vs. 41–44% for other mechanisms. Severe head injuries were common in bicycles, E-scooters, and pedestrians. Torso injuries (thorax/abdomen) were more frequent in motor vehicles and 2-wheel vehicles. Severe extremity injuries were mainly seen in motorised 2-wheel vehicles and pedestrian accidents (figure 2) 48% of patients underwent surgery in the first 24 hours, with the type of procedure aligned to their respective injury profiles. Emergency orthopedic procedures were most frequent in motorised 2-wheel vehicles and pedestrians (79% and 71%). Bicycles and E-scooters had the highest rates of neurosurgical procedures (22% and 26%). Emergency visceral surgery was more common in motor vehicle cases (17%). The 30-day ICU mortality was significantly higher in pedestrians (15.7% [95% CI, 14.6–16.9]) and lowest in motorised 2-wheel vehicles (5.0% [4.6–5.4]), compared to other mechanisms (p < 0,001): 7.6% [7.1–8.1] in motor vehicles, 10.0% [8.5–11.1] in bicycles, and 6.5% [4.4–9.1] in E-scooters.
Conclusion
Pedestrians represent a vulnerable population, with higher injury burden and mortality. Motorised 2-wheel vehicles showed lower mortality, likely due to fewer serious TBIs, especially compared to cyclists and E-scooters.
Auteurs
Martin PLAUD (1), Simon ARCHER (2), Arthur JAMES (3), Jean-Denis MOYER (4), Elodie LANG (5), Tobias GAUSS (6), Benjamin RIEU (7), Jean-Baptiste BOUILLON-MINOIS (7), Thomas BOTREL (3), Julien POTTECHER (8), Sophie NOVELLI (9), Marie WERNER (1) - (1)Département D'anesthésie-Réanimation, Hôpital Bicêtre, Aphp., Le Kremlin Bicêtre, France, (2)Ap-Hp Hôpital Bicêtre, Le Kremlin-Bicêtre, France, (3)Service D'acceuil Des Polytraumatisés-Sspi, La Pitié Salpétrière, Ap-Hp., Paris, France, (4)Département D'anesthésie-Réanimation, Chu Côte De Nacre, Caen, France, (5)Département D'anesthésie-Réanimation, Hegp, Ap-Hp, Paris, France, (6)Département D'anesthésie-Réanimation, Chu Grenoble Alpes, Grenoble, France, (7)Département D'anesthésie-Réanimation, Chu De Clermont-Ferrand, Clermont-Ferrand, France, (8)Département D'anesthésie-Réanimation, Hôpitaux Universitaitres De Strasbourg, Strasbourg, France, (9)Université Paris-Saclay, Uvsq, Inserm, Cesp, Ap-Hp Hôpital Bicêtre, Le Kremlin Bicêtre, France