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Factors associated with inappropriate use of emergency departments: findings from a cross-sectional national study in France
  1. Diane Naouri1,2,
  2. Guillaume Ranchon3,
  3. Albert Vuagnat4,
  4. Jeannot Schmidt5,6,
  5. Carlos El Khoury3,7,
  6. Youri Yordanov1,8
  7. On behalf of French Society of Emergency Medicine
  1. 1 Sorbonne Université, AP-HP, Hôpital Saint Antoine, Service d'Accueil des Urgences, Paris, France
  2. 2 Centre for Research in Epidemiology and Population Health, French National Institute of Health and Medical Research (INSERM U1018), Université Paris-Saclay, Université Paris-Sud, UVSQ, Villejuif, France
  3. 3 Emergency Department, Médipôle, Villeurbanne, France
  4. 4 Biostatistics and Bioinformatics (DIM), University Hospital, Dijon, France
  5. 5 Emergency Department, Clermont-Ferrand University Hospital, Clermont Ferrand, France
  6. 6 EA 4679, Université Clermont Auvergne, Clermont Ferrand, France
  7. 7 RESCUe-RESUVal, INSERM, HESPER EA 7425, Lyon, France
  8. 8 Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, UMR-S 1136, Paris, France
  1. Correspondence to Dr Diane Naouri, AP-HP, Hôpital Saint Antoine, Service d'Accueil des Urgences, Paris, France; naouri.diane{at}gmail.com

Abstract

Background Inappropriate visits to emergency departments (EDs) could represent from 20% to 40% of all visits. Inappropriate use is a burden on healthcare costs and increases the risk of ED overcrowding. The aim of this study was to explore socioeconomic and geographical determinants of inappropriate ED use in France.

Method The French Emergency Survey was a nationwide cross-sectional survey conducted on June 11 2013, simultaneously in all EDs in France and covered characteristics of patients, EDs and counties. The survey included 48 711 patient questionnaires and 734 ED questionnaires. We focused on adult patients (≥15 years old). The appropriateness of the ED visit was assessed by three measures: caring physician appreciation of appropriateness (numeric scale), caring physician appreciation of whether or not the patient could have been managed by a general practitioner and ED resource utilisation. Descriptive statistics and multilevel logistic regression were used to examine determinants of inappropriate ED use, estimating adjusted ORs and 95% CIs.

Results Among the 29 407 patients in our sample, depending on the measuring method, 13.5% to 27.4% ED visits were considered inappropriate. Regardless of the measure method used, likelihood of inappropriate use decreased with older age and distance from home to the ED >10 km. Not having a private supplementary health insurance, having universal supplementary health coverage and symptoms being several days old increased the likelihood of inappropriate use. Likelihood of inappropriate use was not associated with county medical density.

Conclusion Inappropriate ED use appeared associated with socioeconomic vulnerability (such as not having supplementary health coverage or having universal coverage) but not with geographical characteristics. It makes us question the appropriateness of the concept of inappropriate ED use as it does not consider the distress experienced by the patient, and segments of society seem to have few other choices to access healthcare than the ED.

  • emergency department
  • primary care
  • healthcare quality improvement
  • health services research
http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

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Footnotes

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  • French Society of Emergency Medicine Collaborators group We woud like all members of the Frenche Society of Emergency Medicine who helped filling the questionnaire on the day of the survey: Abalea L, MD (Brest), Abdelhadi M, MD (Chalautre la Petite), Achouri A, MD (Libourne), Adi O, MD (St Jean d’Angely), Agbessi A, MD (Boulogne Billancourt), Ahmed M, MD (Koungou), Ait Ali M, MD (Amboise), Ait Idir T, MD (Arnas), Ait Oual A, MD (St Amand Montrond), Akendegue J, MD (Bourgoin Jallieu), Al Bourgol S, MD (Ambilly), Al Tabchi A, MD (Belmont-sur-Vair), Alarcon P, MD (Maubeuge), Alayrangues G, MD (St Barthelemy—Antilles), Alazia M, MD (Marseille), Alazia ML, MD (Marseille), Albert J, MD (Cabestany), Alexander R, MD (Appilly), Allix V, MD (Le Mans), Amama H, MD (Auxerre), Amellal F, MD (Narbonne), Amiens E, MD (Issoire), Amrane A, MD (Le Blanc Mesnil), Ancelin P, MD (Mont de Marsan), Andre A, MD (Pontarlier), Andritsakis O, MD (L’Union), Andronikof M, MD (Clamart), Anfart E, MD (Biarritz), Arabeyre G, MD (Melun), Arnault F, MD (Vannes), Ascofare IC, MD (Amilly), Asdrubal J, MD (Macon), Auroy V, MD (Pontivy), Bah T, MD (Bordeaux), Bailly B, MD (Chaumont), Ballestrazzi V, MD (Armentieres), Ballouz M, MD (Provins), Bandaly F, MD (Vierzon), Banihachemi JJ, MD (Echirolles), Bar C, MD (Brignoles), Barriere P, MD (Nantes), Bartou C, MD (Villeneuve-sur-Lot), Bassil J, MD (Laval), Battaglini P, MD (Aubagne), Baudot V, MD (Le Pont de Beauvoisin), Baugnon D, MD (Verdun), Baure JJ, MD (Rochetaillee), Beaujean F, MD (Tulle), Bedioui A, MD (Almont les Junies), Begnis R, MD (Champagnole), Belabbas H, MD (Ales), Belkhodja H, MD (Compiegne), Bello M, MD (Royan), Benabbas S, MD (Amecourt), Benadda A, MD (Perigueux), Benaissa A, MD (Arnas), Bengrina M, MD (Remiremont), Benmouffok A, MD (L’Aigle), Benmoulai A, MD (Les Adjots), Bennour A, MD (Lille), Benoit D, MD (Baratier), Bergeron C, MD (Villeneuve St Georges), Bersou M, MD (Moissac), Bertheil S, MD (Dax), Billaud N, MD (Metz), Bissolokele P, MD (Fougueyrolles), Blenet JC, MD (Perpignan), Blondeel D, MD (Paris), Blum O, MD (St Priest), Bonelle P, MD (Autheux), Bongrand C, MD (Nogent-sur-Marne), Borel-Kuhner J, MD (Eaubonne), Borsa-Dorion A, MD (Vandoeuvre les Nancy), Bouayad-Agha K, MD (Strasbourg), Boubakar L, MD (Apt), Boubia T, MD (Cosne Cours-sur-Loire), Bouguellid M, MD (Quimperle), Boularan J, MD (Castres), Boumpoutou R, MD (Pau), Bouquillon J, MD (Lille), Bourgeois S, MD (Avignon), Bousquet A, MD (Saintes), Bouvet P, MD (Agones), Brabander D, MD (L’Aiguillon), Braconnier L, MD (St Quentin), Braud F, MD (Cesson Sevigne), Braun F, MD (Metz), Braun JB, MD (Montbeliard), Braun JB, MD (Belfort), Breant I, MD (Livry-sur-Seine), Brilland R, MD (Tarare), Brochet F, MD (Montlucon), Bronet N, MD (Lille), Brousse B, MD (Louviers), Broustal E, MD (Pointe-à-Pitre), Brouste Y, MD (Fort de France), Bulle S, MD (Decines Charpieu), Bultez B, MD (Sisteron), Burckel S, MD (Digne les Bains), Burin B, MD (Nantes), Busseuil C, MD (Montelimar), Cabirol L, MD (Lunel), Campagne J, MD (Guilherand Granges), Canivet I, MD (Fort de France), Capelle P, MD (Nimes), Carbajal R, MD (Paris), Cardona J, MD (Poitiers), Carolet C, MD (Reims), Carpentier F, MD (Grenoble), Carret V, MD (La Seyne-sur-Mer), Carret V, MD (Toulon), Castera F, MD (St Girons), Caucat C, MD (Le Chesnay), Caumon L, MD (Aurillac), Cauvy-Martin S, MD (Bagnols-sur-Ceze), Cavalli P, MD (Roanne), Cayarcy C, MD (Beaumont), Cayrel P, MD (Rodez), Chabaille E, MD (Compiegne), Chabot P, MD (Sedan), Chace A, MD (Villeneuve St Georges), Chaillan D, MD (Sarlat la Caneda), Chaillet O, MD (Thiers), Chakouri A, MD (Aubenas), Chamouilli JM, MD (Toulon), Champly F, MD (Cordon), Champvillard J, MD (Jonzac), Chantepie C, MD (La Ferte Bernard), Charestan P, MD (Aulnay-sous-Bois), Charles JY, MD (Autun), Charlier F, MD (Auberville la Campagne), Charpente F, MD (Montpellier), Charpentier E, MD (Clermont), Charpentier S, MD (Toulouse), Charroin D, MD (St Priest en Jarez), Chasle V, MD (Rennes), Chatoui F, MD (Montpellier), Chehab F, MD (Peronne), Chekroun A, MD (Blois), Cherhabil N, MD (Aire-sur-l’Adour), Cheron G, MD (Paris), Chery N, MD (Pont-à-Mousson), Chevallot N, MD (Romilly-sur-Seine), Chhuy F, MD (Stains), Chonion F, MD (Avallon), Choquet C, MD (Paris), Chretien C, MD (Charleville Mezieres), Claret M, MD (Agnin), Claudet I, MD (Toulouse), Claussner F, MD (Forbach), Cochet-Monier B, MD (Montmorency), Cohen D, MD (Reims), Cointin M, MD (Avignon), Cojocaru B, MD (Colombes), Cojocaru R, MD (Strasbourg), Colin B, MD (Carpentras), Colin-Gorski AM, MD (Argenteuil), Colombani G, MD (Buisson), Combes L, MD (Longjumeau), Comoz H, MD (Rouen), Compagnon F, MD (Coulommiers), Conduche C, MD (Neuilly-sur-Seine), Conte M, MD (Mende), Corege D, MD (Chalon-sur-Saone), Coste V, MD (Montauban), Costes P, MD (Creil), Couillard C, MD (Fontenay le Comte), Couleru G, MD (Pau), Courtot F, MD (Menton), Crepieux O, MD (St Lo), Crocheton N, MD (Champigny-sur-Marne), Crouan JL, MD (St Gregoire), Cueille N, MD (St Junien), Curac S, MD (Clichy), D’andigne E, MD (Villenave d’Ornon), Dabas JP, MD (Arthies), Dalmon F, MD (Chambery), Daoud P, MD (Montreuil), Daoudi M, MD (Beauvain), Darviot E, MD (Angers), De Albasini F, MD (Albiez le Jeune), De Bastard L, MD (Versailles), De Bouguelmouna H, MD (Lormont), De Cagny B, MD (Amiens), De Letter A, MD (Meaux), De Pontual L, MD (Bondy), De Talance M, MD (Epinal), De Touchard P, MD (Langon), Debas O, MD (Ambleon), Debuc E, MD (Paris), Dechaume JL, MD (St Avold), Decroix A, MD (Oyonnax), Degrange P, MD (Rillieux la Pape), Delaire L, MD (Angouleme), Delannoy X, MD (Montmorillon), Delefosse F, MD (Dreux), Delgado G, MD (Hyeres), Delporto S, MD (Quincy-sous-Senart), Demiere E, MD (Nemours), Demil H, MD (Saverne), Depil-Duval A, MD (Evreux), Dequin PF, MD (Chambray les Tours), Der Sahakian G, MD (Grillon), Descamps L, MD (Calmels Et le Viala), Deschamps P, MD (Ennery), Deshayes JL, MD (Le Mans), Desmettre T, MD (Besancon), Devienne J, MD (Arras), Deville F, MD (Limoges), Devos F, MD (Lievin), Deweerdt E, MD (St Gaudens), Dhaou H, MD (Aubergenville), Dheu C, MD (Colmar), Diallo D, MD (Brunelles), Diani A, MD (Acy Romance), Dianteill S, MD (Yerres), Dieckmann K, MD (Blois), Dinant L, MD (Porto Vecchio), Dizabo F, MD (Juvisy-sur-Orge), Dolhem P, MD (St Quentin), Donati JF, MD (Marseille), Douart-Leger C, MD (Neufchateau), Draou B, MD (St Claude), Dubart A, MD (Bethune), Dubouix F, MD (Toulouse), Duche M, MD (Auxerre), Ducreux B, MD (Arnas), Dugas L, MD (Campistrous), Duncan G, MD (Boulogne-sur-Mer), Dupeyron R, MD (Pont l’Abbe), Duplain C, MD (St Chamond), Dupuis E, MD (La Trinite en Martinique), Eckart P, MD (Caen), Ehlinger P, MD (Altkirch), El Andaloussi M, MD (Aubigny), El Arabi J, MD (Cognac), El Cadi T, MD (Vesoul), El Dalati S, MD (Le Blanc), El Idreissi T, MD (Aix en Diois), El Kohen R, MD (Lille), El-Bez M, MD (Evry), Elczar S, MD (Basse Terre), Elias O, MD (Gonesse), Epain D, MD (Lagny-sur-Marne), Escat F, MD (Muret), Escudier V, MD (Balesmes-sur-Marne), Eskandanian A, MD (Bourg en Bresse), Esturoune G, MD (St Jean de Luz), Eyer D, MD (Strasbourg), Faour A, MD (Bernay), Faranpour F, MD (Niort), Faure I, MD (Bordeaux), Favier P, MD (Hazebrouck), Favre-Mercuret C, MD (Apremont), Ferracci S, MD (Pointe-à-Pitre), Ferrand C, MD (Paimpol), Fiani N, MD (Chateau Thierry), Figuere P, MD (Marignane), Flodrops H, MD (St Pierre de la Réunion), Fontaine JP, MD (Paris), Foskett P, MD (Beziers), Fossay C, MD (Fontainebleau), Foucault J, MD (Flers), Fradin P, MD (La Roche-sur-Yon), Francini V, MD (Mantes la Jolie), Freys M, MD (Dijon), Frigui L, MD (Joigny), Fringant MJ, MD (Toul), Froger E, MD (Romans-sur-Isere), Fuzet A, MD (Agnat), Gaffinel C, MD (Etampes), Gaid M, MD (Montlucon), Galvez A, MD (Caen), Ganansia O, MD (Paris), Garitaine P, MD (Gassin), Garnier N, MD (Chassagny), Garraud P, MD (Gueret), Gaspari T, MD (Granville), Gauclere V, MD (Annonay), Gaudin B, MD (Vernon), Gelee C, MD (Lannion), Gelly JM, MD (Salon de Provence), Georges N, MD (Guingamp), Georget F, MD (Amilly), Gerardin D, MD (Beduer), Ghemari T, MD (Bagnolet), Gibey S, MD (Dole), Gilavert PJ, MD (Gien), Giraud I, MD (Montpellier), Glastre C, MD (Pringy), Gnansounou M, MD (Maubeuge), Godescence C, MD (Roubaix), Goix L, MD (Livry-sur-Seine), Gottwalles Y, MD (Colmar), Goulmy M, MD (Bar le Duc), Gouraud F, MD (Meaux), Gov C, MD (Ade), Govindoorazoo S, MD (Montlucon), Graille JP, MD (Aubagne), Griffet J, MD (Grenoble), Grizon-Samit V, MD (Perigueux), Guenot I, MD (Decize), Guenoun L, MD (La Ciotat), Guet L, MD (Trappes), Gueugniaud PY, MD (Lyon), Guibellino P, MD (Marseille), Guyet S, MD (Fontaine la Mallet), Guyon-Veuillet R, MD (Vitry le Francois), Haas H, MD (Nice), Haesevoets M, MD (Albertville), Hallouche D, MD (Argentan), Hamelin V, MD (Chenove), Hammel JL, MD (Tarbes), Hamza L, MD (Bobigny), Harchaoui S, MD (Lisieux), Harisolofo-Tafika J, MD (Crest), Hascoet JM, MD (Nancy), Hassam J, MD (Bastia), Hauet P, MD (Nantes), Hellio R, MD (Orsay), Henry R, MD (Alencon), Hernandez G, MD (Moulins), Herno E, MD (Redon), Herve T, MD (Pont Audemer), Hilal M, MD (Vendome), Ho Ba Tho JJ, MD (Massy), Houareau C, MD (Bourg St Maurice), Hourdin N, MD (Chateaubriant), Huet F, MD (Dijon), Humbert K, MD (Dieval), Hyrien JP, MD (Clamart), Idir C, MD (Bergerac), Immoune Y, MD (Troyes), Issa-Brunet L, MD (Mulhouse), Jacob F, MD (Millau), Jacob X, MD (Pierre Benite), Jacques-Antoine Y, MD (St Benoit de la Réunion), Jacquet V, MD (Orange), Jammes D, MD (Frejus), Janssen P, MD (Beauzelle), Javaud N, MD (Bondy), Javouhey E, MD (Bron), Jean P, MD (Marseille), Jedrecy C, MD (Dourdan), Job E, MD (Meudon), Joly LM, MD (Rouen), Joly M, MD (St Denis), Jomin E, MD (Orthez), Joseph-Louisia J, MD (St Martin—Antilles), Jourdain De Muizon J, MD (Loudun), Jouve JL, MD (Marseille), Kadi L, MD (Armes), Kadi M, MD (Ancenis), Kahn JP, MD (Airon Notre Dame), Kannass M, MD (Nevers), Kareh R, MD (Ermont), Kayemba Kay’s S, MD (Dreux), Kefif F, MD (Courchelettes), Kezza C, MD (St Laurent du Maroni), Kfoury M, MD (Abbeville), Khalaf L, MD (Any Martin Rieux), Khelaf M, MD (Creteil), Khodr Z, MD (St Omer), Kone-Pau I, MD (Le Kremlin Bicetre), Kops L, MD (Mulhouse), Kosayyer M, MD (Sarreguemines), Kozisek S, MD (Flers), Kristic S, MD (Paris), Labes P, MD (Bayonne), Labidi M, MD (Bayeux), Lablanche C, MD (Lyon), Lacampagne F, MD (Bourges), Lacrampe B, MD (Douai), Ladent JM, MD (Bruay la Buissiere), Lafforgue E, MD (Tarbes), Lafleur F, MD (Gonesse), Lagarde S, MD (Cagnes-sur-Mer), Lahlou H, MD (Vitry-sur-Seine), Laichour C, MD (Maisons Laffitte), Laisney N, MD (St Lo), Lamalle D, MD (Arches), Lamont P, MD (Agen), Lamrani C, MD (Beaulieu les Loches), Lanastre B, MD (Briancon), Langlais A, MD (Besancon), Lansade P, MD (Calvi), Lansari M, MD (Verneuil-sur-Avre), Lardeur JY, MD (Poitiers), Larroque D, MD (Toulouse), Lavagna L, MD (Montreuil), Lazaro L, MD (Bayonne), Lazim A, MD (Les Brunels), Lazzarotto D, MD (St Vallier), Le Dreff P, MD (Marseille), Le Gal C, MD (Les Sables d’Olonne), Le Gall C, MD (Argenteuil), Le Guen T, MD (Cayenne), Le Renard A, MD (Brix), Le Sire F, MD (Fontaine la Mallet), Lebars Y, MD (Burlats), Lecoules N, MD (Toulouse), Leflon L, MD (Epernay), Legagneur M, MD (Forbach), Legalloudec E, MD (Beauvais), Lehot H, MD (Metz), Lejri N, MD (Haguenau), Leloup P, MD (Saumur), Lepine T, MD (Abzac), Lepori M, MD (Soissons), Leroux L, MD (Pessac), Leroy C, MD (Colombes), Lesage P, MD (Chambery), Lestavel P, MD (Henin Beaumont), Leveau P, MD (Bressuire), Levraut J, MD (Nice), Levy M, MD (Evreux), Lher E, MD (Brest), Libong L, MD (Conflans-sur-Anille), Lignel M, MD (Mayenne), Lionel B, MD (Montauban), Louis F, MD (Grasse), Loup P, MD (Toulouse), Loyer A, MD (Alleuze), Lubrano O, MD (St Denis de la Réunion), Lucas F, MD (Escaufourt), Luhata J, MD (Denain), Luigi S, MD (Martigues), Lutz C, MD (St Julien en Genevois), Mado P, MD (Firminy), Magd S, MD (Nice), Mahai A, MD (Sarcelles), Maignal R, MD (Albi), Maillet L, MD (Castelnau de Guers), Maisonneuve A, MD (Valenciennes), Maitre O, MD (Orleans), Mangin Y, MD (Beziers), Mansour V, MD (Lisieux), Mansouri A, MD (Osny), Manya J, MD (Perpignan), Marchand D, MD (Fougeres), Marguet C, MD (Rouen), Marianne PJ, MD (St Pierre de la Réunion), Marin-Braun F, MD (Strasbourg), Marinthe B, MD (St Dizier), Mariotti JC, MD (Cherbourg Octeville), Marot Y, MD (Tours), Marquet JL, MD (Cellule), Martel E, MD (Evreux), Martelli V, MD (Ajaccio), Martin D, MD (La Chapelle du Noyer), Martin O, MD (Nancy), Martin-Delgado M, MD (Macon), Martin-Laval A, MD (Marseille), Martinet A, MD (Bethune), Martinez M, MD (Montbrison), Masmoudi R, MD (Paris), Massol V, MD (Dieppe), Matas O, MD (Vienne), Mathieu E, MD (Suresnes), Maugard T, MD (Cherbourg Octeville), Mauger C, MD (Gaillon-sur-Montcient), Mazet B, MD (Angers), Megarni S, MD (La Roche-sur-Yon), Mehrsa K, MD (Le Chesnay), Mehu G, MD (Quimper), Mekerri H, MD (Pithiviers), Menot E, MD (Laon), Mercier JC, MD (Paris), Meress N, MD (Clermont Ferrand), Merlaud C, MD (Royan), Merle F, MD (Cannes), Mescam M, MD (Douarnenez), Meyer F, MD (Lyon), Meyer G, MD (Senlis), Meyran S, MD (Lyon), Mezard P, MD (Aulnay-sous-Bois), Mier L, MD (Laval), Milleret MJ, MD (Sens), Mimouni M, MD (Auxerre), Mingasson P, MD (Manosque), Minguet JM, MD (Draguignan), Minodier P, MD (Marseille), Miramont JP, MD (Albi), Mitamona J, MD (Marmande), Mittler B, MD (St Louis), Mokdadi K, MD (Lyon), Monnet C, MD (Charigny), Monnet M, MD (Aix les Bains), Monroche G, MD (Angers), Montesinos C, MD (Bagneres de Bigorre), Montesquieu F, MD (La Bastide l’Eveque), Mora M, MD (Narbonne), Morel C, MD (Echirolles), Morignot D, MD (Grenoble), Mory O, MD (St Priest en Jarez), Mougel C, MD (St Die Des Vosges), Mougin K, MD (St Denis de la Réunion), Mouriesse D, MD (Bourg en Bresse), Mourou H, MD (Carcassonne), Mourtada MV, MD (Avranches), Moussouni H, MD (Tourcoing), Mouthemy G, MD (Laon), Mselati JC, MD (Orsay), Muller D, MD (Mably), Muller S, MD (Rambouillet), Mzoughi M, MD (Niort), Nace L, MD (Nancy), Nahani A, MD (Gray), Nampont A, MD (Autoire), Nancel-Penard S, MD (Ambleville), Nasr F, MD (St Quentin), Navarro A, MD (Istres), Neuilly C, MD (Tremblay en France), Niederhoffer C, MD (Mulhouse), Nigoghossian P, MD (Arles), Niziolek C, MD (Briey), Obert L, MD (Besancon), Ohayon Y, MD (Barbey), Ollivier F, MD (Dinan), Ourvois P, MD (Calais), Pacchioni F, MD (Gap), Paget P, MD (Amberieu en Bugey), Pailler-Pradeau C, MD (Selestat), Pamart P, MD (Cambrai), Pantaleo V, MD (St Laurent du Var), Papaix-Puech M, MD (Kourou), Paquirimo¤dine R, MD (Thiais), Paradi T, MD (Auch), Pasgrimaud L, MD (La Trinite en Martinique), Patella F, MD (Baie Mahault), Patin MN, MD (St Cloud), Pellerin S, MD (Sens), Pereyre M, MD (Bayonne), Peribois G, MD (Thonon les Bains), Perreaux F, MD (Clamart), Persillon C, MD (Oloron Ste Marie), Peure C, MD (Montfermeil), Phlippoteau C, MD (Creteil), Picaud S, MD (Villeurbanne), Pignon P, MD (Lens), Pillet P, MD (Bordeaux), Pinel P, MD (Sete), Plaisance P, MD (Paris), Plas M, MD (La Teste de Buch), Pochet F, MD (Wattrelos), Pohlmann E, MD (Foix), Poirel C, MD (Le Chalard), Poirier P, MD (Chateau Gontier), Pons I, MD (Aubagne), Poquet G, MD (Favieres), Porche M, MD (Arpajon), Portecop P, MD (Grand Bourg), Potinet-Pagliaroli V, MD (Lyon), Poujol B, MD (Cholet), Pouyanne I, MD (Pau), Prigent G, MD (Voiron), Principe A, MD (Morlaix), Pugnière JP, MD (Ollioules), Quilliec C, MD (Antony), Rajaonarivony JP, MD (Chauny), Rakaa A, MD (Venissieux), Rama S, MD (Campome), Rambaud O, MD (Challans), Ranai R, MD (La Rochelle), Raphael M, MD (Le Kremlin Bicetre), Ray P, MD (Paris), Razafindranazy L, MD (Soissons), Renard A, MD (Marseille), Renaud G, MD (Lons le Saunier), Renize J, MD (Brive la Gaillarde), Revue E, MD (Barjouville), Ricarhibon A, MD (Beaumont-sur-Oise), Richard P, MD (Nimes), Rigo C, MD (Montpellier), Rimet Y, MD (Aix en Provence), Riollot JC, MD (Caen), Riou B, MD (Paris), Risler JP, MD (Aisey-sur-Seine), Riviere C, MD (Ares), Roche JM, MD (Reims), Roland-Billecart D, MD (La Chapelle Montligeon), Romeo B, MD (Amiens), Rosa D, MD (Luneville), Roseau P, MD (Ambert), Rothe MR, MD (St Brieuc), Rouby D, MD (Ussel), Rougetet C, MD (Annemasse), Roupie E, MD (Caen), Sadat K, MD (Nanterre), Saf M, MD (Arpajon), Sanza E, MD (St Georges de Didonne), Sarda H, MD (Ennery), Sattonnet P, MD (Thionville), Sava E, MD (Clermont Ferrand), Savary D, MD (Pringy), Sawalha S, MD (Thann), Schinkel D, MD (Metz), Schlegel J, MD (Haguenau), Schneider JM, MD (Thionville), Schneider M, MD (Sarrebourg), Schol C, MD (Seclin), Schuster M, MD (Guebwiller), Schweig T, MD (Chinon), Scouarnec C, MD (Pessac), Seaume H, MD (Longjumeau), Sebton D, MD (Beauvais), Seguin P, MD (Rennes), Semhoun M, MD (Aunay-sur-Odon), Senee D, MD (Bloye), Sentias C, MD (Coutances), Siagni S, MD (Anglade), Sidhoum A, MD (Strasbourg), Sidialy S, MD (Grande Synthe), Simon N, MD (Poissy), Simon-Libchaber E, MD (Corbeil Essonnes), Smaiti N, MD (Lille), Soliveau G, MD (Le Puy en Velay), Soulat L, MD (Chateauroux), Souquiere L, MD (Brest), Soussan V, MD (Boulogne Billancourt), Soussi M, MD (Cognet), Storme D, MD (Vichy), Strozyk L, MD (Bois Guillaume), Subtil F, MD (St Cyr-sur-Loire), Suffys I, MD (Romorantin Lanthenay), Tabyaoui S, MD (Montceau les Mines), Tahir A, MD (Limoges), Tailhan R, MD (Boujan-sur-Libron), Taki B, MD (Fecamp), Taleb Benbiab Djaouad M, MD (Les Aires), Tandonnet P, MD (Poitiers), Tap R, MD (Rochefort), Taquet N, MD (Aulnoy lez Valenciennes), Tatulli T, MD (Ales), Telitel N, MD (Strasbourg), Testaert E, MD (Le Havre), Texier S, MD (Lorient), Thiery P, MD (Fourmies), Thomas L, MD (Brest), Tilhet-Coartet S, MD (Lyon), Tillaux A, MD (Baromesnil), Tisseron B, MD (Orleans), Tisseron M, MD (Beru), Tixier L, MD (St Etienne), Torres A, MD (Carcassonne), Touil M, MD (La Fleche), Trarieux F, MD (Aubervilliers), Treguer J, MD (Landerneau), Troller S, MD (La Rochelle), Tschill C, MD (Chatellerault), Tuil E, MD (Paris), Ursulescu N, MD (Belfort), Vachon I, MD (Chambeon), Valdenaire G, MD (Bordeaux), Vallejo C, MD (Limoges), Vallet B, MD (Beaune), Vannson MO, MD (Remiremont), Vanrenterghem B, MD (Dunkerque), Vansteenkiste N, MD (St Denis), Varin A, MD (Cricqueboeuf), Vauguet E, MD (Caen), Verdeil J, MD (Nice), Verley L, MD (St Malo), Vervel C, MD (Compiegne), Viala T, MD (Aix en Provence), Viallon A, MD (St Priest en Jarez), Viant E, MD (St Mande), Vicente P, MD (Cahors), Vigneron P, MD (Lorient), Vinciguerra D, MD (Toulon), Violet S, MD (Castelnau Le lez), Voisin X, MD (Antibes), Voituret N, MD (Paray le Monial), Volait G, MD (Le Havre), Vrignaud B, MD (Nantes), Vuillermoz F, MD (Anglars Nozac), Wadih S, MD (Ambres), Wahiche M, MD (Privas), Wargon M, MD (Bry-sur-Marne), Wiener P, MD (Vitre), Wingert D, MD (Wissembourg), Wohler A, MD (Agen), Wongeczowski O, MD (Levallois Perret), Wuilmet L, MD (Chalons en Champagne), Ximenes A, MD (Aicirits Camou Suhast), Younsi S, MD (Vire), Yousfi R, MD (St Nazaire), Zamoum D, MD (Mont St Martin), Zamour C, MD (Valence), Zane D, MD (Augan), Zaoui A, MD (Issoudun), Zegar T, MD (Amiens), Zerga M, MD (Chevreville), Ziade E, MD (Le Creusot), Zimmermann S, MD (Assainvillers), Zix AM, MD (Saverne), Zunino FM, MD (Aix en Provence).

  • Contributors DN and YY were involved in the study data analysis, interpretation of results and drafting the manuscript. CEK and GR were involved in the study data analysis and interpretation of results. AV and JS were involved in the study conception, data analysis and interpretation of results. All the authors critically revised the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data may be obtained from a third party and are not publicly available.

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