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Master Thesis

Accidents de la voie publique à Marie-Galante, du 1er janvier 2016 au 31 décembre 2018

Abstract : Context: Road traumas represent 13.1 deaths per 105 inhabitants in Guadeloupe, with 41.2 deaths for 105 inhabitants among the 18-24 years old (vs. 5.3 and 11.4 respectively in Metropolitan France. Marie-Galante (MG), part of the Guadeloupe islands, 30km from Pointe-à-Pitre, with 10,867 inhabitants, is strongly impacted. The management of the victims involves organizational specificities, especially for the most serious patients, with the necessity of helicopter transfers to the University Hospital Center of Guadeloupe (CHUG) either directly from the accident site or secondarily after a management through the Sainte Marie Hospital Center (CHSM) of MG. Objectives: 1) Epidemiological description of road accident victims (RAV) in MG ; 2) Evaluation of initial medical care of the most serious victims. Materials and methods: Retrospective observational study from January 1st, 2016 to December 31st, 2018, including all RAV victims managed by the Medical Emergency and Resuscitation Service (SMUR) and/or by the CHSM Emergency Department (ED). The contextual and clinical victims data were collected and the patients were distributed according to the following severity Vittel Criteria (VC): - Unstable: at least one criteria: PAS <90mmHg despite volume expansion, Glasgow Score (GS) ≤8, catecholamine use, SaO2 <90% ; - Critical: at least one criteria: PAS >90mmHg after volume expansion, GS 9-13, anatomic lesions according to VC ; - Potentially serious: without vital distress criteria with velocity criteria or aggravating factors according to VC ; - Stable: without any of the previous criteria. Results: During the 3 years, 499 RAV victims required a rescue or medical management in MG: 33% involving light vehicles (14% non-belted), 43% involving 2-motorized-wheels (27% un-helmeted) and 12% involving bicycles. The population is young (29 [21-49]) and mostly male (77%). Of these, 423 were analyzed: 6 (1.4%) were Unstable, 11 (2.6%) Critical, 142 (34%) Potentially Severe, and 264 (62%) Stable. CHSM ED managed 95% of the victims, 7 were directly transferred to the CHUG by helicopter, 52 secondarily after a CHSM first support. At the end, 100% of Unstable patients and 90.9% of Critics were admitted to the CHUG. The medical records of patients transferred to the CHUG revealed significantly shorter delays in primary vs secondary transferred, respectively 148 [136 - 174] min versus 262 [203 - 488] min (p <0.001 95% CI (169.7 - 312.1). Conclusion: This study highlights the high incidence of road traumas in Marie-Galante. The creation of a trauma management protocol should make possible the improvement of medical management, particularly regarding the most serious patients and should allow a decrease of delays. 
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Alexis Fremery. Accidents de la voie publique à Marie-Galante, du 1er janvier 2016 au 31 décembre 2018. Médecine humaine et pathologie. 2019. ⟨dumas-02892848⟩

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