1. 21 st November 2007 Maryann Hardy University of Bradford Accidental Injury in Primary School-Aged Children Maryann Hardy Senior Lecturer University of Bradford

2. 21 st November 2007 Maryann Hardy University of Bradford 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.

3. 21 st November 2007 Maryann Hardy University of Bradford 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

4. 21 st November 2007 Maryann Hardy University of Bradford 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 (1 st April 2004 – 31 st March 2005) –based on PHIS recommendations

5. 21 st November 2007 Maryann Hardy University of Bradford 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 wards61 547 –Craven wards 5 321 –Pendle wards 2 982

6. 21 st November 2007 Maryann Hardy University of Bradford 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%)

7. 21 st November 2007 Maryann Hardy University of Bradford Data Collection Age Sex Postcode Ward of habitation SES calculation Ethnicity Self declared Based on 17 point UK census ethnicity coding tool

8. 21 st November 2007 Maryann Hardy University of Bradford 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.) Monday25/7/04 19.00 Keighley Swimming pool Climbing slide steps

9. 21 st November 2007 Maryann Hardy University of Bradford 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

10. 21 st November 2007 Maryann Hardy University of Bradford 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

11. 21 st November 2007 Maryann Hardy University of Bradford A&E Attendances 10140 attendances by 9300 children Number of attendances AGH No (%)BRI No (%) 123456123456 2975 (91.48%) 230 (7.07%) 40 (1.23%) 5 (0.15%) 1 (0.03%) 6325 (91.83%) 481 (6.98%) 70 (1.02%) 10 (0.15%) 2 (0.03%) 0 Total3 2526 888

12. 21 st November 2007 Maryann Hardy University of Bradford Child Ethnicity Data missing 3087(33.18%) Declined information1214(13.05%) White British3905(41.99%) Asian1019(10.96%) Other BME 76(0.82%) Ethnicity Data

13. 21 st November 2007 Maryann Hardy University of Bradford Ethnic GroupAGH n o (%) BRI n o (%) Combined n o (%) White White British White Irish White Other Mixed Heritage White & Black Caribbean White & Black African White & Asian Mixed Other Asian / Asian British Indian Pakistani Bangladeshi Asian Other Black / Black British Caribbean African Black Other Other Chinese Other ethnic group Data 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) - 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) Total2975 (100)6325 (100)9300 (100)

14. 21 st November 2007 Maryann Hardy University of Bradford Ethnic GroupAGH n o (%) BRI n o (%) Combined n o (%) 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) Total2975 (100)6325 (100)9300 (100) Ethnicity Data

15. 21 st November 2007 Maryann Hardy University of Bradford Ethnic GroupAGH n o (%) BRI n o (%) Combined n o (%) 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) Total2975 (100)6325 (100)9300 (100) Ethnicity Data

16. 21 st November 2007 Maryann Hardy University of Bradford Population Characteristics 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)

17. 21 st November 2007 Maryann Hardy University of Bradford Population Characteristics 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)

18. 21 st November 2007 Maryann Hardy University of Bradford SES QuintilesWhite British No (%) Asian No (%) AGH 1234512345 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) Total2215282 BRI 1234512345 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) 1668735 Child socio-economic status

19. 21 st November 2007 Maryann Hardy University of Bradford Population Characteristics Characteristic White British No (%)n=3905 Asian/Asian British No (%) n=1019 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)

20. 21 st November 2007 Maryann Hardy University of Bradford Attendance Wards BRI Catchment area Attendance area

21. 21 st November 2007 Maryann Hardy University of Bradford Attendance Wards AGH Catchment area Attendance area

22. 21 st November 2007 Maryann Hardy University of Bradford Ward proportional attendance

23. 21 st November 2007 Maryann Hardy University of Bradford High attendance wards WardDistanceAttendanceProportion (%) Glusburn (1)2-5km88/36424.2% Sutton in Craven (1)2-5km77/38919.8% Heaton (3)1-2km450/240418.7% West Craven (1)10-20km29/16617.5% Keighley West (3)2-5km379/217917.4% Thornton (3)2-5km254/153016.6% Skipton South (3)5-10km78/47716.4% Cowling (1)5-10km41/25116.3% Keighley South (4)5-10km296/184716.0%

24. 21 st November 2007 Maryann Hardy University of Bradford WardDistanceAttendanceProportion (%) Glusburn (1)2-5km88/36424.2% Sutton in Craven (1)2-5km77/38919.8% Heaton (3)1-2km450/240418.7% West Craven (1)10-20km29/16617.5% Keighley West (3)2-5km379/217917.4% Thornton (3)2-5km254/153016.6% Skipton South (3)5-10km78/47716.4% Cowling (1)5-10km41/25116.3% Keighley South (4)5-10km296/184716.0% Baildon (1)5-10km102/15246.7% Rombalds (1)5-10km121/17337.0% Queensbury (2)5-10km205/21319.6% Idle (1)5-10km175/168710.4% Wyke (3)5-10km219/193211.3% Aire valley & Loth. (1)2-5km46/39711.6% High attendance wards

25. 21 st November 2007 Maryann Hardy University of Bradford Other Wards WardDistanceAttendanceProportion (%) Bradford Moor (5) 5-10km 423/347312.2% Great Horton (3) 1-2km 313/226913.8% Bowling (5) 5-10km 388/288013.5% University (5) 1-2km 514/364914.1% Little Horton (5) 2-5km 392/268514.6% Undercliffe (4) 2-5km 331/212515.6% Toller (4) <1km553/346715.9%

26. 21 st November 2007 Maryann Hardy University of Bradford Analysis Activity at time of injury Mechanism of injury Injury diagnosis Injured anatomy

27. 21 st November 2007 Maryann Hardy University of Bradford Injury Severity AGH No (%) BRI No (%) Combined No (%) Severe Moderate Minor 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) Total3252688810140

28. 21 st November 2007 Maryann Hardy University of Bradford Patient Disposal Injury DiagnosisAGH No (%) BRI No (%) Combined No (%) Admitted Hospital OP GP follow-up Discharged Died Left A&E department Missing 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) Total3252688810140

29. 21 st November 2007 Maryann Hardy University of Bradford Government priority areas Injury causeSevere No (%) Moderate No (%) Minor No (%) Severity Missing No (%) Total RTA – pedestrian Fire & thermal injuries Drowning Cycling 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 Total92 (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%

30. 21 st November 2007 Maryann Hardy University of Bradford 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%

31. 21 st November 2007 Maryann Hardy University of Bradford Severe injuries WardStudy proportionProportion 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%

32. 21 st November 2007 Maryann Hardy University of Bradford Severe injuries Ward (SES)Study proportionProportion 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% 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%

33. 21 st November 2007 Maryann Hardy University of Bradford Fractures WardStudy proportionProportion Ward population University (5)76 children (4.7%)2.1% Bowling (5)69 children (4.3%)2.4% Bradford Moor (5)68 children (4.2%)1.1% Heaton (3)68 children (4.2%)2.8% Keighley West (3)65 children (4.0%)3.0% Undercliffe (4)64 children (4.0%)3.0%

34. 21 st November 2007 Maryann Hardy University of Bradford WardStudy proportionProportion Ward population University (5)76 children (4.7%)2.1% Bowling (5)69 children (4.3%)2.4% Bradford Moor (5)68 children (4.2%)1.1% Heaton (3)68 children (4.2%)2.8% Keighley West (3)65 children (4.0%)3.0% Undercliffe (4)64 children (4.0%)3.0% 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

35. 21 st November 2007 Maryann Hardy University of Bradford Pedestrian RTA WardStudy proportionProportion Ward population Heaton (3)14 children (7.9%)0.6% Little Horton (5)13 children (7.3%)0.5% University (5)12 children (6.7%)0.3% Keighley West (3)11 children (6.2%)0.5% Toller (4)10 children (5.6%)0.3% Bowling (5)8 children (4.5%)0.3% Bradford Moor (5)8 children (4.5%)0.2% Tong (5)8 children (4.5%)0.4% Undercliffe (4)8 children (4.5%)0.4%

36. 21 st November 2007 Maryann Hardy University of Bradford WardStudy proportionProportion Ward population Heaton (3)14 children (7.9%)0.6% Little Horton (5)13 children (7.3%)0.5% University (5)12 children (6.7%)0.3% Keighley West (3)11 children (6.2%)0.5% Toller (4)10 children (5.6%)0.3% Bowling (5)8 children (4.5%)0.3% Bradford Moor (5)8 children (4.5%)0.2% Tong (5)8 children (4.5%)0.4% Undercliffe (4)8 children (4.5%)0.4% Embsay/Eastby (1)1 child (0.6%)0.6% Pedestrian RTA

37. 21 st November 2007 Maryann Hardy University of Bradford Vehicle Passenger RTA WardStudy proportionProportion Ward population Toller (4)27 children (11.3%)0.8% Undercliffe (4)21 children (8.8%)1.0% University (5)20 children (8.3%)1.0% Heaton (3)19 children (8.0%)0.8% Bradford Moor (5)15 children (6.3%)0.4% Odsal (3)15 children (6.3%)0.7% Bowling (5)14 children (5.8%)0.5% Little Horton (5)13 children (5.4%)0.5%

38. 21 st November 2007 Maryann Hardy University of Bradford WardStudy proportionProportion Ward population Toller (4)27 children (11.3%)0.8% Undercliffe (4)21 children (8.8%)1.0% University (5)20 children (8.3%)1.0% Heaton (3)19 children (8.0%)0.8% Bradford Moor (5)15 children (6.3%)0.4% Odsal (3)15 children (6.3%)0.7% Bowling (5)14 children (5.8%)0.5% Little Horton (5)13 children (5.4%)0.5% Gargrave & Mal (1)2 children (0.8%)0.7% Aire Valley & Loth (1)2 children (0.8%)0.5% Vehicle Passenger RTA

39. 21 st November 2007 Maryann Hardy University of Bradford School attendances WardStudy proportionProportion Ward population Toller (4)124 children (5.71%)3.6% University (5)114 children (5.3%)3.1% Heaton (3)106 children (4.9%)4.4% Keighley West (3)106 children (4.9%)4.9% Keighley North (2)96 children (4.4%)4.4% Bradford Moor (5)91 children (4.2%)2.6% Bowling (5)89 children (4.1%)3.1%

40. 21 st November 2007 Maryann Hardy University of Bradford WardStudy proportionProportion Ward population Toller (4)124 children (5.71%)3.6% University (5)114 children (5.3%)3.1% Heaton (3)106 children (4.9%)4.4% Keighley West (3)106 children (4.9%)4.9% Keighley North (2)96 children (4.4%)4.4% Bradford Moor (5)91 children (4.2%)2.6% Bowling (5)89 children (4.1%)3.1% 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 South22 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

41. 21 st November 2007 Maryann Hardy University of Bradford Conclusions Children attending AGH & BRI A&E –Are of different ages –Are of different ethnicity –Are from diverse economic backgrounds –Travel different distances

42. 21 st November 2007 Maryann Hardy University of Bradford 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

43. 21 st November 2007 Maryann Hardy University of Bradford 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

44. 21 st November 2007 Maryann Hardy University of Bradford 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?

45. 21 st November 2007 Maryann Hardy University of Bradford Thank you M.L.Hardy1@bradford.ac.uk M.L.Hardy1@bradford.ac.uk