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1 Provisional 1 monthly topic of interest: admitted patient care emergency admissions 2 and unplanned accident and emergency attendances 3 caused by road traffic accidents This report focuses on hospital episodes caused by road traffic accidents in the period from October 2013 to Data from this period are currently provisional and therefore subject to change. Researchers have speculated that road traffic accidents could be as high as third in the list of causes of disabilities and premature deaths throughout the world by the year From hereon in, admitted patient care emergency admissions will be referred to as finished admission episodes, while unplanned accident and emergency attendances will be referred to as accident and emergency attendances. The Department of Transport have reported between 2003 and , on average: the mode of transport with the highest passenger casualty rate was motorcycles (4,145 per billion passenger kilometres for passengers who were killed, seriously or slightly injured), pedal cycles had the second highest rate (3,761 per billion passenger kilometres), cars and buses/coaches had much lower casualty rates of 241 and 151 per billion passenger kilometres, respectively, vans had an even lower casualty rate of 62 per billion passenger kilometres, meanwhile, pedestrians had a casualty rate of 1,605 per billion passenger kilometres. Key facts Provisional data for the period October 2013 to 2014 show for road traffic accidents: Admitted Patient Care (APC) There were 52,061 finished admission episodes (FAEs) this year compared to 48,624 FAEs in the previous year, representing a 7.1% rise. In the last five years, the months which recorded the fewest FAEs were December to February, whereas the months with the most recorded FAEs have either been or August. Males had a higher admission rate than females in all age groups. The age group with the highest rate of admission for males was the group (192.2 per 100,000 of the population). The 80 and over age group had the highest rate of admission amongst women (126.6 per 100,000). 17.5% of admissions were caused by a pedal cyclist injuring themselves in a non-collision transport accident 6. The most common primary diagnosis 7 of a hospital admission caused by a transport accident was the fracture of the lower leg (including ankle) (10.9%). Meanwhile, diagnostic imaging procedures were recorded as the most common main procedure 8 (13.3%) where a procedure took place. However, 32.4% of FAEs resulted in no operation being performed. Bristol, North Somerset, Somerset and South Gloucestershire Area Team 9 had the highest rate of FAEs attributable to road traffic accidents (1,250.3 per 100,000 FAEs), and Birmingham and the Black Country had the lowest rate (691.1 per 100,000 FAEs). Accident and Emergency (A&E) There were 233,212 A&E attendances this year compared to 226,510 attendances in the previous year, representing a 3.0% increase. In the past five years, or February often saw the lowest number of A&E attendances, meanwhile was the month with the highest number of A&E attendances four times in the same time period. Both genders illustrated similar trends. The age group had the highest rate of attendance for both males and females, 1,136.4 and per 100,000 of the population respectively. Males had a higher attendance rate than females in all age groups. 16.9% of A&E attendances caused by traffic accidents had a primary diagnosis of a sprain or ligament injury. However, 18.5% of episodes resulted in no diagnosis being recorded. Meanwhile, 48.8% of A&E attendances resulted in guidance or advice as the main form of treatment. 11.1% of attendances required medication to be administrated. Most A&E attendances (73.9%) took place between 0900 hrs and 1959 hrs. The hour of the day which saw the highest proportion of A&E attendances (8.0%) was from 1800 hrs to 1859 hrs hrs to 0559 hrs recorded the lowest proportion of attendances (0.5%). 15.9% of A&E attendances occurred between 2000 hrs and midnight. Lancashire Area Team had the highest rate of A&E attendances caused by road traffic accidents (2,133.9 per 100,000 A&E attendances), whereas London Area Team had the lowest rate (725.0 per 100,000 A&E attendances).

2 Crude rate (A&E attendances per 100,000 of the population) Crude rate (FAEs per 100,00 of the population) Number of hospital episodes Chart 1: 5 year time series of the number of FAEs and A&E attendances caused by road traffic accidents, October 2013 to FAEs A&E attendances Chart 2: Rate of FAEs caused by road traffic accidents by age group and gender, October 2013 to Male Female Age group Chart 3: Rate of A&E attendances caused by road traffic accidents by age group and gender, October 2013 to Male Female Age group

3 Primary diagnosis Primary diagnosis 0% 2% 4% 6% 8% 10% 12% 14% 16% 18% 20% External cause of injury Chart 4: 10 most recorded external causes of injury relating to FAEs caused by road traffic accidents, October 2013 to 2014 Car occupant injured in other and unspecified transport accidents Pedal cyclist injured in collision with car, pick-up truck or van Car occupant injured in collision with fixed or stationary object Motorcycle rider injured in collision with car, pick-up truck or van Car occupant injured in non-collision transport accident Motorcycle rider injured in non-collision transport accident Animal-rider or occupant of animal-drawn vehicle injured in transport accident Car occupant injured in collision with car, pick-up truck or van Pedestrian injured in collision with car, pick-up truck or van Pedal cyclist injured in non-collision transport accident % of FAEs Chart 5: 10 most recorded primary diagnosis for FAEs caused by road traffic accidents, October 2013 to 2014 Other and unspecified injuries of head Intracranial injury Fracture of lumbar spine and pelvis Superficial injury of head Fracture of rib(s), sternum and thoracic spine Fracture of femur Open wound of head Fracture of shoulder and upper arm Fracture of forearm Fracture of lower leg, including ankle 0% 2% 4% 6% 8% 10% 12% % of FAEs Chart 6: 10 most recorded primary diagnosis for A&E attendances caused by road traffic accidents, October 2013 to 2014 Laceration Nothing abnormal detected Head injury Dislocation/fracture/joint injury/amputation Contusion/abrasion Soft tissue inflammation Muscle/tendon injury Diagnosis not classifiable Sprain/ligament injury No diagnosis recorded 0% 2% 4% 6% 8% 10% 12% 14% 16% 18% 20% % of A&E attendances Please note the recording of the A&E diagnosis field is not mandatory therefore data completeness may be affected.

4 % of A&E attendances Treatment Main procedure Chart 7: 10 Most recorded main procedures during a FAE caused by road traffic accidents, October 2013 to 2014 Diagnostic imaging of musculoskeletal system Suture of skin of head or neck Suture of skin of other site Other closed reduction of fracture of bone Primary open reduction of fracture of bone and intramedullary fixation Closed reduction of fracture of bone and internal fixation Primary open reduction of fracture of bone and extramedullary fixation Diagnostic imaging of central nervous system Diagnostic imaging procedures No operation performed 0% 5% 10% 15% 20% 25% 30% 35% % of FAEs Chart 8: 10 Most recorded A&E clinical treatments caused by road traffic accidents, October 2013 to 2014 Intravenous cannula Other (consider alternatives) Other parenteral drugs Prescription/medicines prepared to take away No treatment recorded Observation/electrocardiogram pulse oximetry/head injury/trends None (consider guidance/advice option) Recording vital signs Medication administered Guidance/advice only 0% 10% 20% 30% 40% 50% 60% % of A&E attendances Please note the recording of the A&E treatment field is not mandatory therefore data completeness may be affected. Chart 9: Percentage of A&E attendances caused by road traffic accidents by A&E arrival time, October 2013 to % 9% 8% 7% 6% 5% 4% 3% 2% 1% 0% Time of arrival

5 Table 1: Number of hospital episodes caused by road traffic accidents and corresponding rate per 100,000 of the total number of episodes per Area Team of Treatment, October 2013 to 2014 Area Team of Treatment Arden, Herefordshire and Worcestershire Bath, Gloucestershire, Swindon and Wiltshire Birmingham and the Black Country Bristol, North Somerset, Somerset and South Gloucestershire Cheshire, Warrington and Wirral Cumbria, Northumberland, Tyne and Wear Derbyshire and Nottinghamshire Devon, Cornwall and Isles Of Scilly Durham, Darlington and Tees East Anglia Essex Greater Manchester Hertfordshire and the South Midlands Kent and Medway Lancashire Leicestershire and Lincolnshire London Merseyside North Yorkshire and Humber Shropshire and Staffordshire South Yorkshire and Bassetlaw Surrey and Sussex Thames Valley Wessex West Yorkshire Total FAEs 1,867 1,478 2,213 1,771 1,240 2,033 1,862 1,686 1,395 2,810 1,486 2,724 1,975 1,534 1,431 1,150 7,505 1,425 1,600 1,588 1,401 2,818 1,963 2,656 2,450 52,061 FAE rate 1, , , , , , , , , A&E attendance rate 5,788 1, ,543 1, ,400 1, ,365 1, ,753 2, ,785 1, ,903 1, ,787 1, ,725 1,568.5 A&E attendances 8,718 1, , ,598 1, ,192 1, ,753 1, ,202 2, ,176 1, , ,859 1, ,655 1, ,661 1, ,792 1, ,658 1, ,471 1, ,863 1, ,183 1, ,212 1,269.8 Footnotes: 1. Provisional data These data are provisional and may be incomplete or contain errors for which no adjustments have yet been made. Counts produced from provisional data are likely to be lower than those generated for the same period in the final dataset. This shortfall will be most pronounced in the final month of the latest period, i.e. from the (month 9) April to extract. It is also probable that clinical data are not complete, which may in particular affect the last two months of any given period. There may also be errors due to coding inconsistencies that have not yet been investigated and corrected. 2. Finished admission episodes A finished admission episode (FAE) is the first period of admitted patient care under one consultant within one healthcare provider. FAEs are counted against the year or month in which the admission episode finishes. Admissions do not represent the number of patients, as a person may have more than one admission within the period. 3. Official Source of A&E activity data HES is not the official source of total A&E activity, this is the NHS England situation reports collection - However, HES permits further analysis of A&E activity as there are a range of data items by which HES can be analysed. 4. South West Public Health Observatory "A heavy toll: Road traffic collisions in the South West" PDF can be viewed at 5. Department of Transport RAS Passenger casualty rates by mode: can be found in the "Reported road casualties in Great Britain 2012 all tables" document at https://www.gov.uk/government/statistics/reported-road-casualties-great-britain-annual-report Cause code A supplementary code that indicates the nature of any external cause of injury, poisoning or other adverse effects. Only the first external cause code which is coded within the episode is counted in HES. The list of cause codes used to define traffic accidents in his report is displayed in the table below (Table 2). 7. Primary diagnosis The primary diagnosis is the first of up to 20 (14 from to and 7 prior to ) diagnosis fields in the Hospital Episode Statistics (HES) data set and provides the main reason why the patient was admitted to hospital. 8. Main procedure The first recorded procedure or intervention in each episode, usually the most resource intensive procedure or intervention performed during the episode. It is appropriate to use main procedure when looking at admission details, (e.g. time waited), but a more complete count of episodes with a particular procedure is obtained by looking at the main and the secondary procedures. 9. Area team of treatment This indicates the area team within which the organisation providing treatment was located. 10. Data quality Hospital Episode Statistics (HES) are compiled from data sent by more than 300 NHS trusts in England and from some independent sector organisations for activity commissioned by the English NHS. Health and Social Care Information Centre liaises closely with these organisations to encourage submission of complete and valid data and seeks to minimise inaccuracies. While this brings about improvement over time, some shortcomings remain. Please also note that accident and emergency data relating to The Royal Wolverhampton NHS Trust (RL4) and Sandwell and West Birmingham Hospital NHS Trust (RXK) have been excluded due to data quality issues.

6 Table 2: List of ICD-10 codes used to define traffic accidents Group Pedestrian Pedal cyclist Motorcycle rider Occupant of a 3-wheel motor vehicle Car occupant Occupant of a pick-up truck/van/ heavy transport vehicle Bus occupant Other ICD10 Code V01 V02 V03 V04 V06 V09 V10 V11 V12 V13 V14 V15 V16 V17 V18 V19 V20 V21 V22 V23 V24 V25 V26 V27 V28 V29 V30 V31 V32 V33 V34 V35 V36 V37 V38 V39 V40 V41 V42 V43 V44 V45 V46 V47 V48 V49 V50 V51 V52 V53 V54 V55 V56 V57 V58 V59 V60 V61 V62 V63 V64 V65 V66 V67 V68 V69 V70 V71 V72 V73 V74 V75 V76 V77 V78 V79 V80 V87 V89 V98 V99 Description Pedestrian injured in collision with pedal cycle Pedestrian injured in collision with 2-3 wheeled motor vehicle Pedestrian injured in collision with car pick-up truck or van Pedestrian injured in collision with heavy transport vehicle or bus Pedestrian injured in collision with other non-motor vehicle Pedestrian injured in other and unspecified transport accident Pedal cyclist injured in collision with pedestrian or animal Pedal cyclist injured in collision with other pedal cycle Pedal cyclist injured in collision with 2-3 wheeled motor vehicle Pedal cyclist injured in collision with car pick-up truck or van Pedal cyclist injured in collision with heavy transport vehicle or bus Pedal cyclist injured in collision with railway train or railway vehicle Pedal cyclist injured in collision with other non-motor vehicle Pedal cyclist injured in collision with fixed/stationary object Pedal cyclist injured in non-collision transport accident Pedal cyclist injured in other and unspecified transport accident Motorcycle rider injured in collision with pedestrian or animal Motorcycle rider injured in collision with pedal cycle Motorcycle rider injured in collision with 2-3 wheeled motor vehicle Motorcycle rider injured in collision with car pick-up truck Motorcycle rider injured in collision with heavy transport vehicle Motorcycle rider injured in collision with railway train/railway vehicle Motorcycle rider injured in collision with other non-motor vehicle Motorcycle rider injured in collision with fixed/stationary object Motorcycle rider injured in non-collision transport accident Motorcycle rider injured in other and unspecified transport accidents Occupant 3-wheel motor vehicle injured in collision with pedestrian or animal Occupant 3-wheel motor vehicle injured in collision with pedal cycle Occupant 3-wheel motor vehicle injured in collision with 2-3 wheel motor vehicle Occupant 3-wheel motor vehicle injured in collision with car pick up truck Occupant 3-wheel motor vehicle injured in collision with heavy transport vehicle Occupant 3-wheel motor vehicle injured in collision with railway train Occupant 3-wheel motor vehicle injured in collision with other non-motor vehicle Occupant 3-wheel motor vehicle injured in collision with fixed/stationary object Occupant 3-wheel motor vehicle injured in non-collision transport accident Occupant 3-wheel motor vehicle injured in other/unspecified transport accidents Car occupant injured in collision with pedestrian or animal Car occupant injured in collision with pedal cycle Car occupant injured in collision with 2-3 wheeled motor vehicle Car occupant injured in collision with car pick up truck or van Car occupant injured in collision with heavy transport vehicle or bus Car occupant injured in collision with railway train or railway vehicle Car occupant injured in collision with other non-motor vehicle Car occupant injured in collision with fixed or stationary object Car occupant injured in non-collision transport accident Car occupant injured in other and unspecified transport accident Occupant of a pick-up truck/van injured in collision with pedestrian or animal Occupant of a pick-up truck/van injured in collision with pedal cycle Occupant of a pick-up truck/van injured in collision with 2 or 3 wheeled motor vehicle Occupant of a pick-up truck/van injured in collision with car, pick-up truck or van Occupant of a pick-up truck/van injured in collision heavy transport vehicle Occupant of a pick-up truck/van injured in collision railway train or railway vehicle Occupant of a pick-up truck/van injured in collision other non-motor vehicle Occupant of a pick-up truck/van injured in collision fixed/stationary object Occupant of a pick-up truck/van injured in non-collision transport accident Occupant of pick-up truck or van injured in other and unspecified transport accidents Occupant of a heavy transport vehicle injured in collision with pedestrian or animal Occupant of a heavy transport vehicle injured in collision with pedal cycle Occupant of a heavy transport vehicle injured in collision with 2-3 wheel motor vehicle Occupant of a heavy transport vehicle injured in collision with car, pick-up truck or van Occupant of a heavy transport vehicle injured in collision with heavy transport vehicle or bus Occupant of a heavy transport vehicle injured in collision railway train Occupant of a heavy transport vehicle injured in collision with other non-motor vehicle Occupant of a heavy transport vehicle injured in collision with fixed/stationary object Occupant of a heavy transport vehicle injured in non-collision transport accident Occupant of a heavy transport vehicle injured in other and unspecified transport accidents Bus occupant injured in collision with pedestrian or animal Bus occupant injured in collision with pedal cycle Bus occupant injured in collision with 2-3 wheeled motor vehicle Bus occupant injured in collision with car pick-up truck or van Bus occupant injured in collision with heavy transport vehicle or bus Bus occupant injured in collision with railway train or railway vehicle Bus occupant injured in collision with other non-motor vehicle Bus occupant injured in collision with fixed/stationary object Bus occupant injured in non-collision transport accident Bus occupant injured in other/unspecified transport accident Animal-rider or occupant animal-drawn vehicle injured in transport accident Traffic accident of specific type but victim's mode of transport unknown Motor or non-motor vehicle accident - type of vehicle unspecified Other specified transport accidents Unspecified transport accident

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