Incidence of serious injury: A comparison of emergency hospital admissions for serious injury in Ireland, Northern Ireland, England, Scotland and Wales

Steve Barron, Institute of Public Health in Ireland

Jodie Hope, Information Services Division, NHS National Services Scotland

Prof Ronan Lyons, Steven Macey, College of Medicine, Swansea University and Public Health Wales

Roy Maxwell, Wendi Slater, Public Health England

Injury observatory for Britain and Ireland (IOBI)

Outline

o Injury Observatory for Britain and Irelando Rationaleo Methodo Findingso Limitationso Conclusions

Injury Observatory for Britain and Ireland (IOBI)

o Collaboration involving public health and academic institutions

o Support injury prevention practitioners by making important and relevant information and tools available in one site

o Analysis of injury mortality and occurrence

o Inventory of data sources

o Policy support for prevention

o Evidence base for prevention

o Access to prevention tools

o News and events: Injury Prevention News newsletter

http://www.injuryobservatory.net/

Rationaleo Injury is a major public health issue

o Usefulness of comparing injury occurrence

o Issues in comparing injury occurrence between countries:o Comparable survey data on injury in the community?o Different capacity/admission thresholds in different

countries?

o What can we compare? Hospital admissions for “serious injuries”

Methodo Hospital admission data for 2011o Emergency “inpatient spells”o “Serious injury”: modified set of ICD 10 codes from the New

Zealand Injury Prevention Strategy’s serious injury indicators

o All serious injury: a serious injury code in any diagnosis field o Serious injury by cause and intent: a serious injury code

AND a cause / intent code in any diagnosis fieldo Directly age-standardised rates (DASR)

Completeness of data: All serious injury versus serious injury by cause/intent

Serious injury codes

Serious injury codesAND

Cause/intent codes

Completeness of data: All serious injury versus serious injury by cause/intent

Serious injury codes

Serious injury codesAND

Cause/intent codes

All serious injuries(n=179,380)

Completeness of data: All serious injury versus serious injury by cause/intent

Serious injury codes

Serious injury codesAND

Cause/intent codes

All serious injuries(n=179,380)

Subset of all serious injuries that have cause / intent data(n=159,805):

Scotland 99%Ireland 98%England 89%Wales 72%Northern Ireland 68%

FindingsAll serious injury

o How many serious injuries?

o Are the rates for all serious injuries different between countries?

Serious injury by cause / intent

o How are causes distributed within each country?

o Are the rates by cause different between countries?

o How are intents distributed within each country?

o Are the rates by intent different between countries?

Findings: How many serious injuries?

Number of emergency hospital admissions for all serious injury, 2011Northern Ireland 4,338Ireland 10,253Wales 11,735Scotland 14,382England 138,672

Total 179,380

Findings: Are the rates for all serious injuries different between countries?

• Wales rate significantly higher than others

• England rate significantly lower than others (except Northern Ireland)

• No sex differences in rates within a country apart from Ireland (Male > Female)

Findings: How are causes distributed within each country?

• About two-thirds (63-71%) of serious injuries are due to falls

• 5-8% of serious injuries are due to motor vehicle traffic collisions (MVTC)

• 5-7% of serious injuries are due to struck by or against

• Notable exception: 6% of serious injuries in Northern Ireland are firearm related (<1% in other countries)

Findings: Are the rates by cause different between countries?

Directly age-standardised rate of emergency hospital admissions for serious injury by cause and country, 2011

IRE NI SCOT WAL ENGMVTC 17.4 10.2 13.9 14.2 14.2Fall 214.7 140.0 200.2 198.8 180.0Cut 3.7 3.2 7.2 3.2 2.2Drown 0.4 0.3 0.4 0.5 0.2Fire 0.4 0.3 0.4 0.5 0.2Firearm 0.5 9.0 0.2 0.1 0.2Struck 13.1 4.2 12.7 17.9 14.9Poison 1.4 1.9 1.6 2.5 1.8Other 42.7 21.9 51.5 37.1 33.4

Findings: Are the rates by cause different between countries?

Directly age-standardised rate of emergency hospital admissions for serious injury by cause and country, 2011

IRE NI SCOT WAL ENGMVTC 17.4 10.2 13.9 14.2 14.2Fall 214.7 140.0 200.2 198.8 180.0Cut 3.7 3.2 7.2 3.2 2.2Drown 0.4 0.3 0.4 0.5 0.2Fire 0.4 0.3 0.4 0.5 0.2Firearm 0.5 9.0 0.2 0.1 0.2Struck 13.1 4.2 12.7 17.9 14.9Poison 1.4 1.9 1.6 2.5 1.8Other 42.7 21.9 51.5 37.1 33.4 Significantly higher than other four countries

Findings: Are the rates by cause different between countries?

Directly age-standardised rate of emergency hospital admissions for serious injury by cause and country, 2011

IRE NI SCOT WAL ENGMVTC 17.4 10.2 13.9 14.2 14.2Fall 214.7 140.0 200.2 198.8 180.0Cut 3.7 3.2 7.2 3.2 2.2Drown 0.4 0.3 0.4 0.5 0.2Fire 0.4 0.3 0.4 0.5 0.2Firearm 0.5 9.0 0.2 0.1 0.2Struck 13.1 4.2 12.7 17.9 14.9Poison 1.4 1.9 1.6 2.5 1.8Other 42.7 21.9 51.5 37.1 33.4 Significantly higher than other four countries Significantly lower than other four countries

Findings: Rates by causeoComparisons of sex-specific rates within each

country MVTC, Struck, Other: Male > Female in all

Cut: Male > Female in all except England

Fire: Male > Female in Scotland, England

Firearms: Male > Female in Northern Ireland, Scotland

Drown, Poison: No sex differences

Falls: Female > Male in all five

Findings: How are intents distributed within each country?

• About nine-tenths (89-93%) of serious injuries are unintentional

• 5-7% of serious injuries are due to assaults

• About 2% of serious injuries are due to selfharm (Northern Ireland is higher at 5%)

Findings: Are the rates by intent different between countries?

Directly age-standardised rate of emergency hospital admissions for serious injury by intent and country, 2011

IRE NI SCOT WAL ENGSelfharm 3.5 7.4 4.9 5.0 4.5

Assault 11.4 9.1 17.0 13.8 13.5

Undetermined 1.1 0.4 0.1 0.5 0.4

Unintentional 283.4 176.3 270.7 258.7 232.7

Findings: Are the rates by intent different between countries?

Directly age-standardised rate of emergency hospital admissions for serious injury by intent and country, 2011

IRE NI SCOT WAL ENGSelfharm 3.5 7.4 4.9 5.0 4.5

Assault 11.4 9.1 17.0 13.8 13.5

Undetermined 1.1 0.4 0.1 0.5 0.4

Unintentional 283.4 176.3 270.7 258.7 232.7

Significantly higher than other four countries

Findings: Are the rates by intent different between countries?

Directly age-standardised rate of emergency hospital admissions for serious injury by intent and country, 2011

IRE NI SCOT WAL ENGSelfharm 3.5 7.4 4.9 5.0 4.5

Assault 11.4 9.1 17.0 13.8 13.5

Undetermined 1.1 0.4 0.1 0.5 0.4

Unintentional 283.4 176.3 270.7 258.7 232.7

Significantly higher than other four countries

Significantly lower than other four countries

Findings: Rates by intentoComparisons of sex-specific rates within each

country Selfharm: Male > Female in Ireland,

Northern Ireland, Scotland

Assault: Male > Female in all five

Undetermined/Other: Male > Female in England

Unintentional: Female > Male in Scotland, England

Limitations and issues to consider

o Descriptive rather than analytical study

o Defining “serious injury”

o Completeness of injury coding

o Completeness of cause / intent coding

o Multiple injuries and multiple causes / intents

o Inclusion of readmissions

o Unit of analysis: “Inpatient spells”

Conclusionso Large number of emergency admissions for serious

injury

o Countries have generally similar per cent distributions of causes and intents

o Differences in rates by causes and intents may be partly due to differences in completeness of coding

o Establishing valid incidence rates the first step in comparing countries

Thanks to…o Hospital Inpatient Enquiry Scheme (Ireland)

o Hospital Inpatient System, Hospital Information Branch, Department of Health, Social Services and Public Safety Northern Ireland

o The Scottish Morbidity Record 01 (SMR01) - General/Acute Inpatient and Day Case

o Patient Episode Database for Wales (PEDW) provided by NHS Wales Informatics Service

o Hospital Episode Statistics, Health & Social Care Information Centre (England)

Thank you for listening!

Any comments or questions?