2014.ISDS.Abstracts.Final.pdf


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ISDS 2014 Conference Abstracts

Determinants of Daily Attendances in Emergency 
Departments for Asthma in the Paris Area
Céline Caserio-Schönemann, Alice Sanna, Vanina Bousquet, Sylvia Medina, Mathilde 
Pascal, Marie-Christine Delmas and Anne Fouillet*

French Institute for Public Health Surveillance, Saint Maurice, France

Objective
Description of the temporal pattern of the daily number of 

attendances in emergency departments (ED) for asthma in Paris area 
and identification of the main factors influencing this indicator.

Introduction
In June 2004, the French syndromic surveillance system based on 

the ED has been implemented by the French institute for public health 
surveillance (InVS), starting with 23 ED. In August 2014, about 600 
ED (40,000 daily attendances) are included in the Oscour network, 
recording 80% of the national total attendances.

Asthma is one of the about 60 syndromic indicators monitored each 
day and followed all over the year.

This indicator presents important fluctuations and can be influenced 
by several environmental and infectious but also societal factors. 
Particularly factors like air pollution are known to have both short 
and long term impact on asthma while thunderstorms are associated 
with acute outbreaks of asthma [1-4].

Methods
Using the daily attendances with a clinical diagnosis of asthma 

(J45 and J46 ICD10 codes) recorded in 39 emergency departments 
of the Paris area from 2006 to 2014, the pattern of asthma has been 
described. The intrinsic effects (day-of-week, seasonal period, 
holidays) and external factors have been explored by age group.

Results
In 2014, about 54 attendances for a diagnosis of asthma are 

daily recorded in the ED of Paris region, representing 1.03% of all 
attendances of this region. The part of asthma attendances is higher 
for children under 15 years old than in adults (2.14% versus 0.59%).

While the temporal pattern of the daily number of attendances for 
asthma is quite stable in the adults, the fluctuations of the attendances 
in children present major variations depending on the period of the 
year: a high increase is more particularly observed each September at 
the beginning of the school year (Figure 1).

In 2014 two outbreaks in asthma attendances have been observed 
(Figure 1). The first one occurred in March, between the 13th March 
and the 12th April. During this period, a significant air pollution 
episode was observed between the 6th and the 1st April and affected 
mainly the Ile-de-France region. An intense second episode was 
noticed from 19th to 20th of July, concomitant with a thunderstorm 
episode occurring the same days.

Conclusions
Syndromic surveillance constitutes the only routine system for 

surveillance of asthma at the population scale, enabling the early 
detection of outbreaks like those observed in 2014.

Moreover, this system is included in the national surveillance 
program of short and long term effects of air pollution, with the 
objective to detect and follow-up the rapid impact of major air 
pollution episodes in a near real time.

Figure 1: Daily number of attendances for asthma in the emergency 
departments of Paris area from August 2012 to August 2014 by age group

Keywords
Asthma attendances; Emergency department; France; Influencing 
factor

Acknowledgments

To emergency department data providers and all InVS regional unit for 
their substantial contribution to the system.

References

[1] Jerrett M1, Shankardass K, Berhane K, et al. Traffic-related air 
pollution and asthma onset in children: a prospective cohort study 
with individual exposure measurement. Environ Health Perspect. 2008 
Oct;116(10):1433-8. doi: 10.1289/ehp.10968. Epub 2008 Jun 18.

[2] Winquist A1, Kirrane E, Klein M, et al. Joint effects of ambient air 
pollutants on pediatric asthma emergency department visits in atlanta, 
1998-2004. Epidemiology. 2014 Sep;25(5):666-73. doi: 10.1097/EDE

[3] Dabrera G, Murray V, Emberlin J, et al.Thunderstorm asthma: an 
overview of the evidence base and implications for public health 
advice. QJM. 2013 Mar;106(3):207-17. doi: 10.1093/qjmed/hcs234. 
Epub 2012 Dec 29.

[4] Elliot AJ, Hugues HE, Hugues TC et al. The impact of thunderstorm 
asthma on emergency department attendances across London during 
July 2013. Emerg Med J. 2014 Aug;31(8):675-8.

*Anne Fouillet
E-mail: a.fouillet@invs.sante.fr    

Online Journal of Public Health Informatics * ISSN 1947-2579 * http://ojphi.org * (1):e114, 201