Accidental Injury in Primary School-Aged Children

21st November 2007

Maryann HardyUniversity of Bradford

Maryann HardySenior Lecturer

University of Bradford

21st November 2007

Study Background

Childhood accidental injury:

1. is the most common cause of death;

2. is a major cause of ill health & disability;

3. has high associated financial costs;

4. Is acknowledged to be poorly researched.

21st November 2007

Gaps in our knowledge

• Is burden of injury consistent across childhood

• Are injuries consistent across social and ethnic groups?

• Type of injury• Cause of Injury• Severity of injury

21st November 2007

Study Description• Descriptive epidemiology

– using a cross-sectional survey approach

• Set in Northern England – Bradford & Airedale areas– 1 Urban hospital; 1 Semi-rural hospital

• Encompassed a multi-cultural population

• Children aged 4 – 12 years inclusive– Home address within hospital district– Attending ED– Accidental injury as presenting complaint

• Data collection– undertaken over 1 calendar year (1st April 2004 – 31st March 2005)– based on PHIS recommendations

21st November 2007

Population Areas• BRI

– 30 catchment wards all in Bradford District– 27 urban wards, 3 Rural wards (town & fringe)

• AGH– 33 catchment wards

• 19 Craven District wards• 9 wards served jointly with BRI• 5 wards within Pendle district of Lancashire

– 14 urban wards, 19 rural wards (11 town & fringe, 8 villages)

• Total area population: 69 850– Bradford wards 61 547– Craven wards 5 321– Pendle wards 2 982

21st November 2007

Population Ethnicity (ONS)

• Bradford catchment area: 61 547• White British: 39 492 (64.17%)• Asian: 18 890 (30.69%)• Other ethnicity: 3 165 (5.14%)

• Airedale catchment area: 24 046• White British: 21 201 (88.17%)• Asian: 2 186 (9.09%)• Other ethnicity: 659 (2.74%)

• Study Area (54 wards): 69 850• White British: 47 484 (67.98%)• Asian: 19 044 (27.26%)• Other ethnicity: 3 322 (4.76%)

21st November 2007

Data Collection

• Age

• Sex

• Postcode• Ward of habitation• SES calculation

• Ethnicity• Self declared• Based on 17 point UK census ethnicity coding tool

21st November 2007

Data Collection

When did injury occur? Date Time

Where did injury occur?(eg. street name, park name etc.)

What activity was child doing at the time of accident?(eg. cycling, skating, climbing etc.)

Monday 25/7/04 19.00

Keighley Swimming pool

Climbing slide steps

21st November 2007

Data Analysis

• Summary data • per child • per attendance• per ward

• Exploratory tests• Multiple regression random effects model to take

account of ward clustering• Univariate analysis to determine factors in model,

p<0.2 – factor included

21st November 2007

• Factors in multiple regression model– Age

– 4-6 years; 7-9 years; 10-12 years

– Gender– Ethnicity

– White British; Asian; Other BME

– Deprivation score– Quintiles based on Child Poverty Index of UK IMD 2004

– Distance from home to hospital– Quintiles based on measurement from ward centroid

– Rurality of home environment– Determined by UK Government 2004 ward classification

Data Analysis

21st November 2007

A&E Attendances10140 attendances by 9300 children

Number of attendances

AGH No (%) BRI No (%)

123456

2975 (91.48%) 230 (7.07%) 40 (1.23%) 5 (0.15%) 1 (0.03%) 1 (0.03%)

6325 (91.83%) 481 (6.98%) 70 (1.02%) 10 (0.15%) 2 (0.03%)

Total 3 252 6 888

21st November 2007

Child Ethnicity• Data missing 3087 (33.18%)• Declined information 1214 (13.05%)• White British 3905 (41.99%)• Asian 1019 (10.96%)• Other BME 76 (0.82%)

Ethnicity Data

21st November 2007

Ethnic Group AGH no (%)

BRI no (%)

Combined no (%)

White White British White Irish White OtherMixed Heritage White & Black Caribbean White & Black African White & Asian Mixed OtherAsian / Asian British Indian Pakistani Bangladeshi Asian OtherBlack / Black British Caribbean African Black OtherOther Chinese Other ethnic groupData missing Not declared Not collected

2235 (75.13)2226 (74.82)4 (0.13) 5 (0.17)18 (0.61)3 (0.10)1 (0.03)13 (0.44)1 (0.03)283 (9.51)5 (0.17)255 (8.57) 20 (0.67)3 (0.10)2 (0.07)1 (0.03)1 (0.03)-4 (0.13) 4 (0.13) -433 (14.55)430 (14.45) 3 (0.10)

1688 (26.69)1679 (26.55)1 (0.02)8 (0.13)7 (0.11)1 (0.02)5 (0.08)- - 1 (0.02)736 (11.64)38 (0.60)675 (10.67)16 (0.25)7 (0.11)5 (0.08)- -3 (0.05)2 (0.02)22 (0.35)1 (0.02)21 (0.33)3867 (61.14)784 (12.40) 3083 (48.74)

3923 (42.18)3905 (41.99)5 (0.05)13 (0.14)25 (0.27)4 (0.04)6 (0.06)13 (0.14)2 (0.02)1019 (10.96)43 (0.46)930 (10.0) 36 (0.39)10 (0.11)7 (0.08)1 (0.01)4 (0.04)2 (0.02)26 (0.28)5 (0.05)21 (0.23)4300 (46.24)1214 (13.05)3086 (33.18)

Total 2975 (100) 6325 (100) 9300 (100)

21st November 2007

BRI no (%)

Combined no (%)

Data missing Not declared Not collected

433 (14.55)430 (14.45) 3 (0.10)

3867 (61.14)784 (12.40) 3083 (48.74)

4300 (46.24)1214 (13.05)3086 (33.18)

Total 2975 (100) 6325 (100) 9300 (100)

Ethnicity Data

21st November 2007

BRI no (%)

Combined no (%)

Data missing Not declared Not collected

433 (14.55)430 (14.45) 3 (0.10)

3867 (61.14)784 (12.40) 3083 (48.74)

4300 (46.24)1214 (13.05)3086 (33.18)

Total 2975 (100) 6325 (100) 9300 (100)

Ethnicity Data

21st November 2007

Population Characteristics

Characteristic

White BritishNo (%)n=3905

Asian/Asian British

No (%) n=1019

Age (years) (n =4924)4 – 7 8 – 10 11-12 Gender (n=4924)MaleFemale Socio-economic status (1= least deprived, n=4900)12345Data missing

1401 (35.9)1320 (33.8)1184 (30.3) 2308 (59.1)1597 (40.9)

1527 (39.1)746 (19.1)988 (25.3)285 (7.3)339 (8.7)22 (0.6)

451 (44.3)357 (35.0)211 (20.7) 687 (67.4)332 (32.6)

6 (0.6)185 (18.2)262 (25.7)231 (22.7)333 (32.7)2 (0.2)

21st November 2007

Characteristic

Asian/Asian British

No (%) n=1019

Age (years) (n =4924)4 – 7 8 – 10 11-12 Gender (n=4924)MaleFemale Socio-economic status (1= least deprived, n=4900)12345Data missing

1401 (35.9)1320 (33.8)1184 (30.3) 2308 (59.1)1597 (40.9)

1527 (39.1)746 (19.1)988 (25.3)285 (7.3)339 (8.7)22 (0.6)

451 (44.3)357 (35.0)211 (20.7) 687 (67.4)332 (32.6)

6 (0.6)185 (18.2)262 (25.7)231 (22.7)333 (32.7)2 (0.2)

21st November 2007

SES Quintiles White BritishNo (%)

AsianNo (%)

1335 (60.27) 335 (15.12) 349 (15.76) 193 (8.71) 3 (0.14)

5 (1.77) 134 (47.52) 87 (30.85) 55 (19.50) 1 (0.35)

Total 2215 282

190 (11.39) 411 (24.64) 639 (38.31) 92 (5.52) 336 (20.14)

1 (0.14) 51 (6.94)175 (23.81)176 (23.95)332 (45.17)

1668 735

Child socio-economic status

21st November 2007

Characteristic

Asian/Asian British

No (%) n=1019

Rural/urban home environment (n=4900)

Data missing

Distance to nearest hospital (n=4924)

5-10km

10-20km

897 (23.0)

2986 (76.5)

22 (0.6)

29 (0.7)

291 (7.5)

1136 (29.1)

1174 (30.1)

530 (13.6)

145 (3.7)

2 (0.2)

1015 (99.6)

2 (0.2)

131 (12.9)

291 (28.6)

212 (20.8)

372 (36.5)

11 (1.1)

2 (0.2)

21st November 2007

Attendance Wards BRI

Catchment area Attendance area

21st November 2007

Attendance Wards AGH

Catchment area Attendance area

21st November 2007

Ward proportional attendance

21st November 2007

High attendance wardsWard Distance Attendance Proportion (%)

Glusburn (1) 2-5km 88/364 24.2%

Sutton in Craven (1) 2-5km 77/389 19.8%

Heaton (3) 1-2km 450/2404 18.7%

West Craven (1) 10-20km 29/166 17.5%

Keighley West (3) 2-5km 379/2179 17.4%

Thornton (3) 2-5km 254/1530 16.6%

Skipton South (3) 5-10km 78/477 16.4%

Cowling (1) 5-10km 41/251 16.3%

Keighley South (4) 5-10km 296/1847 16.0%

21st November 2007

Ward Distance Attendance Proportion (%)

Glusburn (1) 2-5km 88/364 24.2%

Sutton in Craven (1) 2-5km 77/389 19.8%

Heaton (3) 1-2km 450/2404 18.7%

West Craven (1) 10-20km 29/166 17.5%

Keighley West (3) 2-5km 379/2179 17.4%

Thornton (3) 2-5km 254/1530 16.6%

Skipton South (3) 5-10km 78/477 16.4%

Cowling (1) 5-10km 41/251 16.3%

Keighley South (4) 5-10km 296/1847 16.0%

Baildon (1) 5-10km 102/1524 6.7%

Rombalds (1) 5-10km 121/1733 7.0%

Queensbury (2) 5-10km 205/2131 9.6%

Idle (1) 5-10km 175/1687 10.4%

Wyke (3) 5-10km 219/1932 11.3%

Aire valley & Loth. (1) 2-5km 46/397 11.6%

High attendance wards

21st November 2007

Other WardsWard Distance Attendance Proportion (%)

Bradford Moor (5) 5-10km 423/3473 12.2%

Great Horton (3) 1-2km 313/2269 13.8%

Bowling (5) 5-10km 388/2880 13.5%

University (5) 1-2km 514/3649 14.1%

Little Horton (5) 2-5km 392/2685 14.6%

Undercliffe (4) 2-5km 331/2125 15.6%

Toller (4) <1km 553/3467 15.9%

21st November 2007

Analysis

• Activity at time of injury

• Mechanism of injury

• Injury diagnosis

• Injured anatomy

21st November 2007

Injury Severity

Injury Severity AGHNo (%)

BRINo (%)

CombinedNo (%)

SevereModerateMinor

Missing

132 (4.06) 636 (19.56)2439 (75.0) 45 (1.38)

381 (5.53)1240 (18.0)4989 (72.43) 278 (4.04)

513 (5.06)1876 (18.50)7428 (73.25)

323 (3.19)

Total 3252 6888 10140

21st November 2007

Patient Disposal

Injury Diagnosis AGHNo (%)

BRINo (%)

CombinedNo (%)

AdmittedHospital OPGP follow-upDischargedDiedLeft A&E departmentMissing

151 (4.64) 657 (20.2) 356 (10.95)2041 (62.76) 1 (0.03) 46 (1.42)

400 (5.81)1509 (21.91) 723 (10.5)3976 (57.72) - 278 (4.04) 2 (0.03)

551 (5.43)2166 (21.36)1079 (10.64)6017 (59.33) 1 (0.01) 324 (3.2) 2 (0.02)

Total 3252 6888 10140

21st November 2007

Government priority areas

Injury cause Severe No (%)

ModerateNo (%)

MinorNo (%)

SeverityMissingNo (%)

RTA – pedestrianFire & thermal injuriesDrowningCycling

37 (23.72) 9 (7.5) 0 (0)46 (8.36)

13 (8.33) 21 (17.5) 0 (0)118 (21.45)

101 (64.74) 87 (72.5) 0 (0)377 (68.55)

5 (3.21)3 (0.25)0 (0)9 (0.18)

156 120 0 550

Total 92 (11.14) 152 (18.4) 565 (68.4) 17 (2.06) 826

Contribution to total attendances 826/10140 = 8.15%

Contribution to Severe injuries 92/513 = 17.93%

21st November 2007

Areas for intervention

• Severe injuries• 513 / 10140 = 5.1%

• Fractures• 1622/10140 = 16.0%

• Pedestrian RTA injuries• 179/10140 = 1.8%

• RTA vehicle occupant injuries• 242/10140 = 2.4%

• School injuries• 2180/10140 = 21.5%

21st November 2007

Severe injuriesWard Study proportion Proportion Ward population

Bradford Moor (5) 31 children (6.1%) 0.9%

University (5) 31 children (6.1%) 0.8%

Little Horton (5) 28 children (5.5%) 1.0%

Great Horton (3) 27 children (5.4%) 1.2%

Toller (4) 25 children (5.0%) 0.7%

Heaton (3) 24 children (4.8%) 1.0%

Keighley West (3) 24 children (4.8%) 1.1%

Bowling (5) 23 children (4.6%) 0.8%

Undercliffe (4) 21 children (4.2%) 1.0%

21st November 2007

Severe injuriesWard (SES) Study proportion Proportion Ward population

Great Horton (3) 27 children (5.4%) 1.2%

Penyghent (1) 3 children (0.6%) 1.6%

Embsay/Eastby (1) 2 children (0.4%) 1.3%

Wibsey (2) 16 children (3.2%) 1.0%

21st November 2007

FracturesWard Study proportion Proportion Ward population

21st November 2007

Ward Study proportion Proportion Ward population

Glusburn (1) 22 children (1.4%) 6.0%

Sutton in Craven (1) 19 children (1.2%) 4.9%

Skipton North (1) 14 children (0.9%) 4.7%

Hellifield (1) 7 children (0.4%) 4.1%

Cowling (1) 9 children (0.6%) 3.6%

Gargrave & Mal. (1) 10 children (0.6%) 3.4%

Craven (1) 50 children (3.1%) 3.1%

Fractures

21st November 2007

Pedestrian RTAWard Study proportion Proportion Ward population

Tong (5) 8 children (4.5%) 0.4%

21st November 2007

Tong (5) 8 children (4.5%) 0.4%

Embsay/Eastby (1) 1 child (0.6%) 0.6%

Pedestrian RTA

21st November 2007

Vehicle Passenger RTAWard Study proportion Proportion Ward population

Odsal (3) 15 children (6.3%) 0.7%

21st November 2007

Odsal (3) 15 children (6.3%) 0.7%

Gargrave & Mal (1) 2 children (0.8%) 0.7%

Aire Valley & Loth (1) 2 children (0.8%) 0.5%

Vehicle Passenger RTA

21st November 2007

School attendancesWard Study proportion Proportion Ward population

Toller (4) 124 children (5.71%) 3.6%

Keighley North (2) 96 children (4.4%) 4.4%

21st November 2007

Toller (4) 124 children (5.71%) 3.6%

Keighley North (2) 96 children (4.4%) 4.4%

Sutton in Craven (1) 31 children (1.4%) 8.0%

Glusburn (1) 26 children (1.2%) 7.1%

Cowling (1) 14 children (0.6%) 5.6%

Skipton East (1) 17 children (0.8%) 5.5%

Skipton South 22 children (1.0%) 4.6%

Bingley Rural (1) 72 children (3.3%) 4.5%

Craven (1) 69 children (3.2%) 4.3%

Penyghent (1) 8 children (0.4%) 4.3%

Thornton (3) 63 children (2.9%) 4.1%

School attendances

21st November 2007

Conclusions

•Children attending AGH & BRI A&E–Are of different ages–Are of different ethnicity–Are from diverse economic backgrounds–Travel different distances

21st November 2007

Conclusions

• When thinking about injury intervention initiatives we need to think about– Injury control:

• the reduction in severity of injuries

– Injury prevention:• The reduction in rates of injury

21st November 2007

Conclusions

• Specific injury issues to be tackled locally– Vehicle passenger injuries– School injury referrals– Local fracture rates

• Also societal issues to consider– Study Executive Summary

21st November 2007

Conclusions

• Service Issues– Large minor injuries attendance

• Do they all need medical care?• Can we offer an alternative service?• Use of ECP’s in primary care sector?• Will this reduce DNA’s and costs?

21st November 2007

Thank youM.L.Hardy1@bradford.ac.uk

Accidental Injury in Primary School-Aged Children

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