1. Unintentional Injuries in Children in Wales with a particular emphasis on Wrexham children aged 0 to 4 Presented by Louise Woodfine, National Public Health Service for Wales Erlas Centre, Wrexham 26.06.2009

2. Content Introduction Burden of unintentional injuries Epidemiology of unintentional injuries in children Availability of data and Limitations Key Messages Recommendations

3. Injuries are a worldwide public health concern. The causes of injuries can be intentional or unintentional and their outcomes can have significant costs to individuals, families and health and care services. Injuries are caused by predictable interactions between individuals and the environment in which they live and work. The term ‘accident’ is no longer used as it tends to suggest that injuries are random events and not amenable to prevention when they usually follow a predictable pattern of exposure and are largely preventable. Increasingly references are made to unintentional injuries or events, such as crashes or collisions, rather than terms such as ‘accidental injury’ or ‘road traffic accident’. Introduction

4. Burden of unintentional injuries Injuries and their consequences produce a heavy burden on society in terms of short and long term disability, mortality, economic loss and health care costs In Wales, injuries account for about three per cent of total deaths, however the distribution of the age of death in those dying is very different from most other causes of death with a high proportion of deaths occurring in the young. After the age of one injury is the first or second leading cause of death in most European countries, including Wales. When a different measure of counting the impact of death is used, potential years of life lost (PYLL) before age 75 injuries account for around 15 per cent of all premature mortality in Wales Unintentional injury related deaths represent a small proportion of the incidence of injuries in the population. Many more adults and children sustain non-fatal injuries

5. Epidemiology of non-fatal unintentional injuries in children Unintentional injuries are the most common cause of death in children over one year of age and they leave many more permanently disabled or disfigured. Children are at high risk of sustaining an injury as they are often absorbed in their own immediate interests and can be oblivious to their surroundings; they only have limited perception of the environment because of their lack of experience or development Data shows that children aged 0 to 4 years have the most unintentional injuries in the home and boys are more likely to have them than girls Amongst children, UK data shows that the most severe injuries are associated with heat and falls from a height. –Older children are more likely to sustain fractures than younger children –Young children have a higher percentage of burns and scalds as well as poisoning and ingestion injuries.

6. UK data show the largest number of childhood injuries in the home are sustained in the living/dining room, however the most serious injuries happen in the kitchen and on the stairs. Every year over 67,000 children experience an injury in the kitchen, 64% of these involve children aged between 0 to 4 years; 58,000 children have injuries on the stairs. Most injuries are sustained between late afternoon and early evening, in the summer, during school holidays and at weekends. Factors such as death in the family, chronic illness, homelessness or moving home can increase the likelihood of a child having an injury Epidemiology of non-fatal unintentional injuries in children cont…..

7. Inequalities in unintentional injuries Childhood injuries are closely linked with social deprivation. Children from poorer backgrounds are 5 times more likely to die as a result of an unintentional injury than children from better off families Poorer and overcrowded housing and lack of safe places to play can increase the risk of injury; these factors are all more common in more deprived population groups.

8. Data Availability and Limitations

9. When people have unintentional injuries what do they do? Go to A and E Visit their GP Self treatment Nothing Therefore difficult to see the whole picture

10. Data sources AWISS (All Wales Injury Surveillance System) –A and E data, funded by WAG –Describes the incidence of unintentional injuries in Wales –Highlights groups at risk, types of injuries sustained and where they occur –Collects information on all injured people attending A and E across Wales in order to support research into targeting and evaluating injury prevention initiatives

11. AWISS - Limitations Limitations to consider: –Doesn’t cover all Wales (WAG currently addressing this through ‘Emergency Department dataset’) –Has limited information on the location, causes and mechanisms of injury –The dataset does not however include all injuries as some individuals may seek medical attention elsewhere such as a GP surgery or they may not seek any medical attention. –Distance to hospital has a strong effect on attendance rates, including child attendance rates. –For those living within a mile of hospital, attendance rates are double those 10 miles away. This holds for injuries with the exception of fractures. –Reasons for this are that minor injuries can be ignored, self treated or treated by other health practitioners such as GP’s and Physiotherapists. –This means that comparing small area maps of many types of injury using A and E data can be misleading –Data at post code level – disclosive/confidentiality, small numbers, missing data and inaccurate postcodes

12. Data sources cont…. PEDW (Patient Episode Data base for Wales) –Managed by Health Solutions Wales –Electronic activity for inpatient and day case activity for welsh residents in NHS hospitals in Wales and England –Records based on finished episodes of care under one consultant

13. Data sources cont…. General practice data –Not consistent between practices –Development of QOF for chronic conditions –Different ways of collecting and recording data in practices

14. Children aged 0 to 4 in Wrexham

15. The chart below show the proportion of the population in Wrexham aged 0 to 4 years which is higher than the average for Wales

16. Unintentional injury related hospital admissions Children aged 0 to 19 years The chart below shows the trend in unintentional injury related admissions to hospital for residents in Wrexham 19 and under. Children aged 0 to 4 account for the highest number of unintentional injury related hospital admissions. Unintentional injury related hospital admissions, children aged 0 to 19 years, Wrexham 1999 to 2003

17. All Wales Data

18. Poisoning/overdose – age distribution The rates for children aged 0-4 are alarmingly high, with almost five per cent of children in this age group attending an accident and emergency department as the result of poisoning/overdose.

19. Childhood burns and scalds Whilst burns and scalds form a relatively low proportion of all injuries they are often quite severe injuries and may result in residual disfigurement and disability. Scalds are a particular problem in young children and most hospital admissions in those aged 0-4 years from thermal injuries are due to scalds. Half of these injuries are due to spilling hot drinks on the child and a quarter are due to excessively hot tap water

20. Bruise/abrasion and laceration/wound – age distribution L acerations/wounds are more common amongst children under 5 years of age whereas children aged 10-19 years had higher rates for bruise/abrasions. Laceration/wound Bruise/abrasion

21. Main location AWISS data relating to the location of injuries shows that most people are injured at home. The most vulnerable age groups for injuries occurring at home are the very young and older persons. Rates for people injured in road traffic incidents peak in the 15-24 age group, whilst rates for people injured in public places peak in the early teenage years. The high rate of childhood injuries in the home reflects the amount of time children spend in this environment, particularly 0 to 4 year olds. The pattern of risk changes as children become older and more independent.

22. Key Messages

23. Injuries are a worldwide and all-Wales public health concern. Unintentional injuries are the most common cause of death in children over one year of age and they leave many more permanently disabled or disfigured. The most vulnerable age groups for injuries occurring at home are the very young (and older persons age 80+). Children in more deprived areas are 5 times more likely to die as a result of an unintentional injury than children from less deprived areas. Children aged 0 to 4 years have the most unintentional injuries in the home Boys are more likely to have an injury than girls

24. Children account for the highest number of attendances at A&E Departments with an unintentional injury or poisoning Of children aged between 0 to 19 in Wrexham, those aged between 0 to 4 accounted for the highest number of unintentional injury related hospital admissions (over a five year period). Poorer and overcrowded housing and lack of safe places to play can increase the risk of injury; these factors are all more common in deprived population groups. The high rate of childhood injuries in the home reflects the amount of time children spend in this environment, particularly 0 to 4 years. Key Messages cont…

25. UK data show the largest number of childhood injuries in the home are sustained in the living/dining room however, the most serious injuries happen in the kitchen and on the stairs. Most injuries are sustained between late afternoon and early evening, in the summer, during school holidays and at weekends UK data show that the most severe injuries in children are associated with heat related injuries and falls from a height. Young children have a higher percentage of burns and scalds as well as poisoning and ingestion injuries than older children; the rates for children aged 0 to 4 are alarmingly high as a result of poisoning/overdose.

26. Recommendations

27. Based on current evidence and data the recommendations are: To target children aged between 0 and 4 in the more deprived areas of Wrexham (as identified through the most recent deprivation data). To use evidenced based interventions to target the home environment paying particular attention to:  Access to poisons, chemicals and medicines  Heat related injuries  Falls from a height  Burns and scalds Recommendations

28. Recommendations cont….. To maximise effectiveness the above should be delivered through a multi-agency partnership approach and complement existing schemes (child safe scheme in the housing department, communities first). Ensure robust monitoring and evaluation processes are in place for existing and new schemes in order to maximise effectiveness and impact on children and their families. Following this report additional information may be obtained at a later date from NPHS regarding ‘the most effective interventions known to reduce the incidence of injury to children’ which will support the development and implementation of local activity.

29. Acknowledgements Claire Jones, Health Information Analysis Team, NPHS Nathan Lester, Health Information Analysis Team, NPHS For further information contact: louise.woodfine@nphs.wales.nhs.uk