Injuries to Children

Data for this section, along with some of the commentary, were provided by The Injury Prevention Manager at NHS Bristoli, ii, iii.

This section looks at injuries to children due to all causes. Some injuries may be treated at an Accident or Emergency Department (BCH, Frenchay Emergency Department or Southmead Minor Injury Unit) while more serious injuries will require admission to BCH. Many of these are discharged on the same day, but over 60% will stay in hospital for one or more overnights.

North Bristol Trust includes a large area of South Gloucestershire, including a significant proportion of the built-up area of Bristol. Frenchay Hospital is located in South Gloucestershire. Hence a large number of children included in the statistics below are actually South Glos residents.

Emergency attendances at A & E departments

Emergency admissions

– Number of admissions
– Length of stay
– Cause of injury

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Emergency attendances at A & E departments

Figure 1 shows visits to Accident & Emergency Departments by children aged 0 ‑ 15 for unintentional injuries during 2007 ‑ 2009. The map is coloured by attendance rate per 1000 population of under 16-year-olds in each LSOA. “Unintentional” injuries can of course include deliberate injuries or those caused by neglect and abuse.

There is a clear link between emergency attendance rates and social deprivation.

Attendance rates vary more than four-fold between LSOAs. Some areas of Southmead and Lockleaze have attendance rates around 400, while areas such as Clifton, Westbury and Redland are around 100. The proximity to Frenchay and Southmead is likely to be a contributory factor, but it is definitely not the whole explanation as there is no such clear hot-spot for a similar distance around the Children’s Hospital. There are known to be cultural differences as to what constitutes an injury that requires hospital treatment, and some parents from ethnic minorities have not realised that treatment was free of charge. NHS Bristol is monitoring this situation and will be carrying out further research to explain the higher incidence in North Bristol.

It is hard to imagine that 40% of all children in an LSOA have attended an Emergency Department, so it is likely that many children have attended more than once in the year. A local study of a sample of 6,200 under-5s during 2003 ‑ 2008 found that 720 (12%) of them attended more than onceii. The difference between LSOAs cannot be accounted for just by multiple attendances.

Health Visitors are informed of every Emergency Department attendance by under-5s so are able to monitor any child protection issuesii.

Figure 1 – Attendance Rates at A & E Departments

Source: Avon IM & T Consortium, NHS Bristol

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Emergency admissions

These are for more serious injuries that require a stay in a hospital bed, rather than being treated in an Emergency Department. Numbers of admissions by ward (LA ward, not hospital ward) correspond to levels of deprivation throughout the city, without the imbalance between north & south as seen in A & E attendances.

Number of admissions

Figure 2 shows numbers of children per 10,000 population admitted to hospital during 2003 ‑ 2009 by age band. There has been a steady rise in admissions over 2003 ‑ 2006, especially in younger and older children. National Statisticsiii show there has been a continual rise in the number of emergency admissions over at least 30 years that cannot be entirely explained. Suggested explanations include:

  • increased illness and frailty linked to an aging population
  • increased public expectations leading to more self-referral to NHS care
  • the effects of incentives in the NHS such as central targets (especially the 4-hour maximum waiting time in A & E introduced in 2004) and new ways of paying hospitals (payment by results)
  • changes in clinical decision-making and more ‘defensive’ medicine
  • increased ability to detect and treat illness
  • changes in data collection and recording
  • changes in care outside hospital such as general practice and social care.

The work of the Nuffield Trust has shown that while these factors have influenced admission rates, they cannot provide the entire explanation for the increase in admissions. Emergency admissions cost the NHS £11 billion per year so it is recognised that more research is needed in this area.

Most of this rise is accounted for by short-stay admissions (zero and one bed-day, see 1.1.1.2). Thus the data do not necessarily indicate that children are experiencing higher numbers, or severity, of injuries. Locally the figures show a steeper rise followed by a slight decline.

Figure 2 – Emergency admissions by age

Source: NHS Bristol

Figure 3 shows admissions of all under-18 year olds by month. Background shading indicates quarters. It shows clear peaks in Q1 & Q2, coinciding with school holidays and the times when children are likely to spend more time outdoors.

Figure 3 – Monthly emergency admissions

Source: NHS Bristol

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Length of stay

Figure 4 shows the number of days each child stayed in hospital after an emergency admission. There are a very large number of short admissions. There has been a question as to whether this is a measure to avoid poor performance in meeting A & E waiting time targets. This may be a partial explanation, but there is evidence that the increasing trend was apparent before these targets were implemented in 2004iii. This is an area that is recognised as requiring further research, as it is a very expensive practice (see above).

Figure 4 – No of days in hospital for emergency admissions

Source: NHS Bristol

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Cause of injury

Table 1 shows the 10 most common causes of injury for children admitted to hospital from 2003 to June 2010.

Table 1 – Cause of injury for children admitted to hospital

Source: NHS Bristol

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[i] Childhood Injury in Bristol, Rob Benington, NHS Bristol, August 2010.

[ii] Rob Benington, Injury Prevention Manager, NHS Bristol, email communications.

[iii] Trends in Emergency Admissions in England 2004–2009, Ian Blunt, Martin Bardsley and Jennifer Dixon. The Nuffield Trust, 2010. Full report available here.

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One Response to Injuries to Children

  1. Rob Benington says:

    The rate of injury is a function of social, economic and environmental factors. Following decades of research into the epidemiology of injury, risk factors for childhood injury are well understood . In Bristol, despite the uncertainties in the data highlighted above, we can be sure that childhood injury is more likely in some parts of the city than others and is more likely to occur in some groups of people. The National Institute of Clinical Excellence (NICE) has recently made recommendations about how best we can keep children safe from unintentional injury, and we should not use uncertainty about causes of changes in admission and attendance statistics to delay implementation of action for which a strong evidence base of effectiveness exists.

    Rob Benington
    Injury Prevention Manager
    NHS Bristol

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