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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

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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 Universityand Public Health Wales

Roy Maxwell, Wendi Slater, Public Health England

Injury observatory for Britain and Ireland (IOBI)


Outline

  • Injury Observatory for Britain and Ireland

  • Rationale

  • Method

  • Findings

  • Limitations

  • Conclusions


Injury observatory for britain and ireland iobi
Injury Observatory for Britain and Ireland (IOBI)

  • Collaboration involving public health and academic institutions

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

  • Analysis of injury mortality and occurrence

  • Inventory of data sources

  • Policy support for prevention

  • Evidence base for prevention

  • Access to prevention tools

  • News and events: Injury Prevention News newsletter

http://www.injuryobservatory.net/


Rationale

  • Injury is a major public health issue

  • Usefulness of comparing injury occurrence

  • Issues in comparing injury occurrence between countries:

    • Comparable survey data on injury in the community?

    • Different capacity/admission thresholds in different countries?

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


  • Method

    • Hospital admission data for 2011

    • Emergency “inpatient spells”

    • “Serious injury”: modified set of ICD 10 codes from the New Zealand Injury Prevention Strategy’s serious injury indicators

    • All serious injury: a serious injury code in any diagnosis field

    • Serious injury by cause and intent: a serious injury code AND a cause / intent code in any diagnosis field

    • Directly age-standardised rates (DASR)


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


    Completeness of data all serious injury versus serious injury by cause intent1
    Completeness of data: All serious injury versus serious injury by cause/intent

    All serious injuries

    (n=179,380)


    Completeness of data all serious injury versus serious injury by cause intent2
    Completeness of data: All serious injury versus serious injury by cause/intent

    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%


    Findings

    All serious injury

    • How many serious injuries?

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

    Serious injury by cause / intent

    • How are causes distributed within each country?

    • Are the rates by cause different between countries?

    • How are intents distributed within each country?

    • Are the rates by intent different between countries?



    Findings are the rates for all serious injuries different between countries
    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
    Findings: How are causes distributed within each country? between countries?

    • 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 r ates by cause
    Findings: countries?Rates by cause

    • Comparisons 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
    Findings: How are intents distributed within each country? countries?

    • 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: Rates by intent countries?

    • Comparisons 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 countries?

    • Descriptive rather than analytical study

    • Defining “serious injury”

    • Completeness of injury coding

    • Completeness of cause / intent coding

    • Multiple injuries and multiple causes / intents

    • Inclusion of readmissions

    • Unit of analysis: “Inpatient spells”


    Conclusions countries?

    • Large number of emergency admissions for serious injury

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

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

    • Establishing valid incidence rates the first step in comparing countries


    Thanks to… countries?

    • Hospital Inpatient Enquiry Scheme (Ireland)

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

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

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

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


    Thank you for listening! countries? Any comments or questions?


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