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Accidental Injury in Primary School-Aged Children

Accidental Injury in Primary School-Aged Children. Maryann Hardy Senior Lecturer University of Bradford. Study Background. Childhood accidental injury: is the most common cause of death; is a major cause of ill health & disability; has high associated financial costs;

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Accidental Injury in Primary School-Aged Children

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  1. Accidental Injury in Primary School-Aged Children Maryann Hardy Senior Lecturer University of Bradford Maryann Hardy University of Bradford

  2. Study Background Childhood accidental injury: • is the most common cause of death; • is a major cause of ill health & disability; • has high associated financial costs; • Is acknowledged to be poorly researched. Maryann Hardy University of Bradford

  3. 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 Maryann Hardy University of Bradford

  4. 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 Maryann Hardy University of Bradford

  5. 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 Maryann Hardy University of Bradford

  6. 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%) Maryann Hardy University of Bradford

  7. Data Collection • Age • Sex • Postcode • Ward of habitation • SES calculation • Ethnicity • Self declared • Based on 17 point UK census ethnicity coding tool Maryann Hardy University of Bradford

  8. Data Collection Monday 25/7/04 19.00 Keighley Swimming pool Climbing slide steps Maryann Hardy University of Bradford

  9. 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 Maryann Hardy University of Bradford

  10. Data Analysis • 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 Maryann Hardy University of Bradford

  11. A&E Attendances 10140 attendances by 9300 children Maryann Hardy University of Bradford

  12. Ethnicity Data 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%) Maryann Hardy University of Bradford

  13. Maryann Hardy University of Bradford

  14. Ethnicity Data Maryann Hardy University of Bradford

  15. Ethnicity Data Maryann Hardy University of Bradford

  16. Characteristic White British No (%)n=3905 Asian/Asian British No (%) n=1019 Age (years) (n =4924) 4 – 7 8 – 10 11-12 Gender (n=4924) Male Female Socio-economic status (1= least deprived, n=4900) 1 2 3 4 5 Data 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) Population Characteristics Maryann Hardy University of Bradford

  17. Characteristic White British No (%)n=3905 Asian/Asian British No (%) n=1019 Age (years) (n =4924) 4 – 7 8 – 10 11-12 Gender (n=4924) Male Female Socio-economic status (1= least deprived, n=4900) 1 2 3 4 5 Data 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) Population Characteristics Maryann Hardy University of Bradford

  18. Child socio-economic status Maryann Hardy University of Bradford

  19. Characteristic White British No (%)n=3905 Asian/Asian British No (%) n=1019 Population Characteristics Rural/urban home environment (n=4900) Rural Urban Data missing Distance to nearest hospital (n=4924) < 1km 1-3km 3-5km 5-10km 10-20km >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) Maryann Hardy University of Bradford

  20. Attendance Wards BRI Catchment area Attendance area Maryann Hardy University of Bradford

  21. Attendance Wards AGH Catchment area Attendance area Maryann Hardy University of Bradford

  22. Ward proportional attendance Maryann Hardy University of Bradford

  23. High attendance wards Maryann Hardy University of Bradford

  24. High attendance wards Maryann Hardy University of Bradford

  25. Other Wards Maryann Hardy University of Bradford

  26. Analysis • Activity at time of injury • Mechanism of injury • Injury diagnosis • Injured anatomy Maryann Hardy University of Bradford

  27. Injury Severity Maryann Hardy University of Bradford

  28. Patient Disposal Maryann Hardy University of Bradford

  29. Government priority areas Contribution to total attendances 826/10140 = 8.15% Contribution to Severe injuries 92/513 = 17.93% Maryann Hardy University of Bradford

  30. 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% Maryann Hardy University of Bradford

  31. Severe injuries Maryann Hardy University of Bradford

  32. Severe injuries Maryann Hardy University of Bradford

  33. Fractures Maryann Hardy University of Bradford

  34. Fractures Maryann Hardy University of Bradford

  35. Pedestrian RTA Maryann Hardy University of Bradford

  36. Pedestrian RTA Maryann Hardy University of Bradford

  37. Vehicle Passenger RTA Maryann Hardy University of Bradford

  38. Vehicle Passenger RTA Maryann Hardy University of Bradford

  39. School attendances Maryann Hardy University of Bradford

  40. School attendances Maryann Hardy University of Bradford

  41. Conclusions • Children attending AGH & BRI A&E • Are of different ages • Are of different ethnicity • Are from diverse economic backgrounds • Travel different distances Maryann Hardy University of Bradford

  42. 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 Maryann Hardy University of Bradford

  43. 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 Maryann Hardy University of Bradford

  44. 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? Maryann Hardy University of Bradford

  45. Thank youM.L.Hardy1@bradford.ac.uk Maryann Hardy University of Bradford

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