Accidents and injuries in under 25s in East Sussex. Hospital admissions and A&E attendances

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1 Accidents and injuries in under 25s in East Sussex Hospital admissions and A&E attendances East Sussex Public Health, May P a g e

2 Contents Summary of key findings: 0-4 years... 3 Summary of key findings: 5 11 years... 4 Summary of key findings: years... 5 Summary of key findings: years... 6 Introduction... 7 Data quality... 8 Public Health Outcomes Framework Indicator... 9 Length of stay of admissions Ward level data - admissions Children s Centre level data - admissions Deprivation analysis of admissions Cause of injury admissions Unintentional injury admissions Deliberate injury admissions Transport accident admissions Falls admissions A&E attendances due to injuries, 2012/ A&E attendances due to road traffic accidents A&E attendances due to assaults A&E attendances due to self-harm Outcome of A&E attendances Appendix rate of admissions - previous indicator definition P a g e

3 Summary of key findings: 0-4 years For the three year period 2010/11 to 2012/13: There were three electoral wards that had significantly higher admission rates than East Sussex. These were Baird, Hollington and Tressell 63% of admissions had a zero length of stay (the highest of all age groups); with 29% having a 1-day length of stay There is a clear association between deprivation and children under 5 years being admitted to hospital due to accidents and injuries There were three children centres clusters that had significantly higher admission rates than East Sussex. These were Bexhill, Hastings, and St Leonards cluster; with 3 children centres in Hastings (The Bridge, East Hastings and Hastings Town) all having significantly higher admission rates than East Sussex Falls were the main cause of admissions (56%), with 15% of admissions due to exposure to inanimate mechanical forces, and 12% due to poisoning The percentage of unintentional injury admissions caused by falls ranged from 54% in Rother to 61% in Lewes 73% of falls occurred within the home, with 1 in 5 of these (19%) a fall from/on stairs or steps. Falls involving a bed accounted for 17% of falls, with 25% of falls occurring outside the home involving playground equipment Around one in ten admissions were due to accidental poisoning, with the lowest percentage in Lewes (8%) and the highest percentage in Rother (16%) For the year 2012/13: Eastbourne and Hastings had the highest rates of A&E attendances due to injuries Other accident made up the majority of causes of A&E injury attendances, with 24% of other accident attendances due to head injuries Hastings had the highest rate for other accident attendances with a diagnosis of head injury and had a significantly higher rate than Lewes, Rother and Wealden districts Around half (52%) of A& E attendances resulted in discharge, with no further treatment required; 7% of attendances resulted in admission (the highest rate of all age groups) 3 P a g e

4 Summary of key findings: 5 11 years For the three year period 2010/11 to 2012/13: There were four electoral wards that had significantly higher admission rates than East Sussex. These were Baird, Hollington, Tressell and Newick 44% of admissions had a zero length of stay, with 42% having a 1-day length of stay There is a clear association between deprivation and children under 15 years being admitted to hospital due to accidents and injuries Falls were the main cause of admissions (64%), with 12% of admissions due to transport accidents, and 11% due to exposure to inanimate mechanical forces The percentage of unintentional injury admissions caused by falls ranged from 56% in Rother to 70% in Eastbourne 25% of falls occurred within the home, with around 1 in 5 (18%) at school or another public administration area. I in 10 (9%) falls occurred at a sports or athletics areas The percentage of unintentional injury admissions due to transport accidents ranged from 10 % in Hastings and Lewes to 17% in Rother Around half (49%) of transport accident admissions were due to cycling accidents and a quarter (26%) due to pedestrian accidents The rate of cycle accident admissions was highest in Rother (7.8 per 10,000 population) and lowest in Eastbourne (1.9 per 10,000 population) For the year 2012/13: Eastbourne and Hastings had the highest rates of A&E attendances due to injuries Other accident made up the majority of causes of A&E injury attendances, with 21% of other accident attendances due to dislocation/fracture/joint injury/amputation A quarter (24%) of other accidents occurred at an educational establishment; 38% occurred at home and 31% in a public place Around half (49%) of A& E attendances resulted in discharge, with no further treatment required; 16% of attendances resulted in referral to a fracture clinic 4 P a g e

5 Summary of key findings: years For the three year period 2010/11 to 2012/13: There were six electoral wards that had significantly higher admission rates than East Sussex. These were Baird, Tressell, Newhaven Denton and Meeching, Newhaven Valley, Bexhill Central, and Ticehurst & Etchingham Falls were the main cause of unintentional injury admissions (42%), with 27% of admissions due to transport accidents. The percentage of unintentional injury admissions caused by falls ranged from 37% in Wealden to 49% in Lewes. Around 1 in 5 (22%) unintentional injury admissions in Hastings were due to transport accidents, with this rising to around 1 in 3 (32%) in Rother 38% of transport accident admissions were due to cycling accidents and around 1 in 5 (19%) as a result of riding an animal The rate of cycle accident admissions was highest in Rother (9.8 per 10,000 population) and lowest in Wealden (5.4 per 10,000 population) The majority (90%) of deliberate harm injury admissions were due to self -harm, with 10% due to assault. The percentage of deliberate harm injury admissions due to self-harm ranged from 78% in Eastbourne to 94% in Wealden. The percentage of deliberate harm injury admissions due to assault ranged from 6% in Wealden to 22% in Eastbourne For the year 2012/13: Hastings had the highest rates of A&E attendances due to injuries and had a significantly higher rate than the rest of East Sussex. Lewes had a significantly lower rate than all other East Sussex districts and boroughs Other accident made up the majority of causes of A&E injury attendances, with 1 in 5 (20%) of attendances due to sports injuries. 26% of other accident attendances were due to dislocation/fracture/joint injury/amputation, and a quarter (24%) of other accidents occurred at an educational establishment and 37% in a public place A&E attendances due to road traffic accidents were lowest in Lewes (n = 25) and highest in Hastings (n = 47) The highest numbers of attendances due to assaults and self-harm across the years age range were for persons aged 17 years; with more males than females attending A&E due to an assault, and more females than males attending A&E due to self-harm across the years age group. 42% of A& E attendances resulted in discharge, with no further treatment required; 20% of attendances resulted in referral to a fracture clinic 5 P a g e

6 Summary of key findings: years For the three year period 2010/11 to 2012/13: Eight electoral wards had significantly higher admission rates than East Sussex. These were Baird, Castle, Darwell, Sidley, Ticehurst & Etchingham, Crowborough Jarvis Brook, Crowborough West and Frant/ Withyham Transport accidents were the main cause of hospital admissions in year olds (31%), followed by falls (30%) and exposure to inanimate mechanical forces (16%). 1 in 4 (25%) unintentional injury admissions in Eastbourne were due to transport accidents, with this figure rising to around 2 in 5 (38%) in Wealden The percentage of unintentional injury admissions caused by falls ranged from 24% in Lewes to 43% in Eastbourne. Around two thirds (63%) of transport accident admissions were caused by a car or motorcycle accident; 15% were due to cycling accidents.) 79% of deliberate harm injury admissions were due to self-harm, with 21% due to assault. The percentage of deliberate harm injury admissions due to self-harm ranged from 74% in Hastings to 82% in Rother and Wealden. The percentage of deliberate harm injury admissions due to assault ranged from 18% in Rother and Wealden to 26% in Hastings For the year 2012/13: Eastbourne and Hastings had the highest rates of A&E attendances due to injuries. Lewes had a significantly lower rate than all other East Sussex districts and boroughs Other accident made up the majority of causes of A&E injury attendances, with 1 in 10 attendances due to sports injuries, and more than 1 in 10 attendances due to deliberate injuries (6% assault and 6% self-harm) A&E attendances for injuries caused by road traffic accidents were highest in the years age group, with rate of attendance (per 10,000 population) highest in Rother and Wealden (although such rates are not significantly different to the East Sussex average) The highest number of A&E attendances due to assault for the years age range were for persons aged 19 to 20 years; with more males than females attending A&E due to an assault across this age group. The rate of A&E attendance due to assaults was highest in Eastbourne and lowest in Wealden. Eastbourne had the highest number of A&E attendances due to self-harm, with the rate significantly higher than the rest of East Sussex. 40% of A& E attendances resulted in discharge, with no further treatment required; 23% of attendances were discharged with follow up with a GP 6 P a g e

7 Introduction This report reviews available data on accidents and injuries for children and young people (under 25 years) in East Sussex. It is based on local data as well as data available nationally. Under the Public Health Outcomes Framework (PHOF), the definition of the indicator for hospital admissions for unintentional and deliberate harm has changed from how admissions due to accidents and injuries were previously monitored, as well as changing the age groups for which the indicator will be published. Public Health England publishes benchmarked data on emergency hospital admissions due to injuries for persons aged 0-14 years, 0-4 years and years. Performance against the new indicator is not comparable to previous published data. This report analyses hospital admissions in line with the new, updated PHOF indicator definition; however for the majority of analyses in this report the age groups 0-4 years, 5-11 years, years and years have been used to align with early years, primary, secondary and further educational provision. An update on performance to 2012/13 for the previous indicator definition for 0-4 year olds and 0-17 year olds is provided in Appendix A. More detailed analysis of hospital admissions and attendances at A&E are also presented to help gain a better understanding of the causes of accidents and to inform the commissioning and delivery of local services that prevent and reduce accidents to children and young people in East Sussex. Definition: Hospital admissions The data covers emergency admissions with injuries selected based on injury codes and relevant external cause codes (ICD10 codes). External cause relates to the reason for the injury e.g. Car occupant injured in transport accident could be the external cause of a head injury. Unintentional injuries relate to causes such as falls and traffic accidents whereas deliberate injuries relate to causes such as assault and self harm. The age covered is 0-24 years inclusive and the indicator is based on the postcode of residence of the admitted person, not necessarily the location where the injury took place. Definition: A&E attendances Information on attendances at A&E is available via local hospital activity data sets. Within the A&E dataset there is a field called patient group, which is used to identify the reason for an A&E episode. There are also broad diagnosis codes available. Patient group codes have been used to identify attendances relating to injuries (road traffic accidents, assaults, self-harm, sports injuries, firework injuries and other accidents). Data presented by geographies relates to where patients live, not where incidents occurred. 7 P a g e

8 Data quality The source of A&E attendance data used in this report is of poorer data quality than hospital admissions, as it is not the official source of A&E data that is used for monitoring purposes. Nationally it is recognised that the A&E data source used in this report has continuing issues regarding the quality and coverage of data, for example missing diagnosis codes. The official source of data used to monitor key standards of care in A&E is overall numbers only, by A&E department. It therefore cannot be used for detailed analyses of any kind. It is important to note that A&E attendance data does not include the East Sussex Minor Injury Units (MIUs) (Lewes, Crowborough and Uckfield) as MIU data is not included in local hospital activity datasets. MIU data is not captured in a way that allows robust analysis of attendances at the units. The NHS Walk-in centres at Eastbourne and Hastings are also not included. 8 P a g e

9 Public Health Outcomes Framework Indicator As can be seen from Figure 1, Hastings has the highest rate of admissions for persons aged 0 14 years in East Sussex and has always had a significantly worse rate than England. Both Hastings and Rother show a decreasing rate over the three year period. In 2012/13 the rate in Eastbourne was significantly higher than for England. Figure 1: rate of admissions by East Sussex local authority children aged 0-14 years, 2010/11 to 2012/13, Public Health Outcome Framework indicator 2.07i Hastings has the highest rate of admissions for 0-4 year olds in East Sussex; and along with Eastbourne, during 2010/11 to 2012/13 both areas have significantly higher rates than England. Hastings, Lewes and Rother all show decreasing rates during the three-year period. (Figure 2) Figure 2: rate of admissions by East Sussex local authority children aged 0-4 years, 2010/11 to 2012/13, Public Health Outcome Framework indicator 2.07i 9 P a g e

10 Figure 3: rate of admissions by East Sussex local authority young people aged years, 2010/11 to 2012/13, Public Health Outcome Framework indicator 2.07ii For all age groups, relative to other areas, Hastings has performed better each year (i.e. each year it ranks lower than previous years [although reflected by a higher number as rank of 1 = worst]). For children aged 0-4 years, all districts/boroughs except Wealden have improved each year relative to the rest of the country. (Tables 1 to 3) Tables 1 to 3: rank of East Sussex local authorities for PHOF indicators (out of 326 local authorities, 1= worst) 0-4s 2010/ / /13 Eastbourne Hastings Lewes Rother Wealden s 2010/ / /13 Eastbourne Hastings Lewes Rother Wealden s 2010/ / /13 Eastbourne Hastings Lewes Rother Wealden P a g e

11 Length of stay of admissions Almost a third (63%) of admissions for children aged 0-4 years have a zero length of stay (admitted and discharged on the same day). Around 1 in 6 admissions (16%) for persons aged years result in a hospital stay of 3 or more days. (Figure 4) Figure 4: length of stay of admissions by age group, 2010/11 to 2012/13 Ward level data - admissions Figures 5 to 8 show the wards in East Sussex that have admission rates that are higher than the East Sussex average, as well as those which have significantly higher rates than East Sussex (i.e. statistically significantly higher), for each of the age groups. Table 4 shows the wards with significantly higher rates than East Sussex for 2010/11 to 2012/13. Table 4: wards with significantly higher rates than East Sussex, 2010/11 to 2012/13 Wards with significantly higher rates than East Sussex 0-4 years 5-11 years years years Baird, Hollington, Tressell Baird, Hollington, Tressell, Newick Baird, Tressell, Newhaven Denton & Meeching, Newhaven Valley, Bexhill Central, Ticehurst & Etchingham Baird, Castle, Darwell, Sidley, Ticehurst & Etchingham. Crowborough Jarvis Brook, Crowborough West, Frant/Withyham 11 P a g e

12 Figure 5: rate of admissions for wards for 0-4 year olds compared to East Sussex, 2010/11 to 2012/13 East Sussex County Council This map is reproduced from Ordanance Survey material with the permission of Ordanance Survey on behalf of the Controller of Her Majesty s Stationary Office Crown copyright. Unauthorised reproduction infringes Crown copyright and may lead to prosecution or civil proceedings Figure 6: rate of admissions for wards for 5-11 year olds compared to East Sussex, 2010/11 to 2012/13 East Sussex County Council This map is reproduced from Ordanance Survey material with the permission of Ordanance Survey on behalf of the Controller of Her Majesty s Stationary Office Crown copyright. Unauthorised reproduction infringes Crown copyright and may lead to prosecution or civil proceedings P a g e

13 Figure 7: rate of admissions for wards for year olds compared to East Sussex, 2010/11 to 2012/13 East Sussex County Council This map is reproduced from Ordanance Survey material with the permission of Ordanance Survey on behalf of the Controller of Her Majesty s Stationary Office Crown copyright. Unauthorised reproduction infringes Crown copyright and may lead to prosecution or civil proceedings Figure 8: rate of admissions for wards for year olds compared to East Sussex, 2010/11 to 2012/13 East Sussex County Council This map is reproduced from Ordanance Survey material with the permission of Ordanance Survey on behalf of the Controller of Her Majesty s Stationary Office Crown copyright. Unauthorised reproduction infringes Crown copyright and may lead to prosecution or civil proceedings P a g e

14 Children s Centre level data - admissions Figure 9 shows the admission rates by children s centre and children s centre clusters for those aged 0-4 years. Hastings, Bexhill and St Leonards clusters all have significantly higher rates than East Sussex. There are 3 children s centres with significantly higher rates than East Sussex; all of which are in Hastings (The Bridge, East Hastings and Hastings Town). Figure 9: rate of admissions for Children s Centres and clusters, 0-4 year olds, 2010/11 to 2012/13 14 P a g e

15 Deprivation analysis of admissions There is a clear association between deprivation (as measured by the Index of Multiple Deprivation 2010) and children aged under 5 years and under 15 years admitted to hospital as an emergency due to accidents and injuries (Figures 10 and 11). For young people aged years the association is not as clear. (Figure 12) Figure 10: rate of admissions for 0-4 year olds by deprivation, 2010/11 to 2012/13 Figure 11: rate of admissions for 0-14 year olds by deprivation, 2010/11 to 2012/13 15 P a g e

16 Figure 12: rate of admissions for year olds by deprivation, 2010/11 to 2012/13 16 P a g e

17 Cause of injury admissions Due to the change in the indicator definition for the PHOF, all injury admissions are counted, regardless of whether an external cause has been recorded or not (previously admissions were counted based on external cause codes only). Over the 3 year period, 14% of admissions have an injury diagnosis but with no external cause code recorded. For these admissions it is not possible to know the cause of the injury, but it is possible to know the type of the injury (e.g. head injury, burns). There were also a small number of admissions (n=11, 0.02%) which are coded as undetermined intent ; this is where it is unclear whether the injury was as a result of a deliberate or accidental event. Potentially most of these admissions could be due to self-harm. Figure 13: type of injury cause for East Sussex admissions, by age group, 2010/11 to 2012/13 The majority of admissions for children aged 0-4 years (81%) and 5-11 years (86%) are due to unintentional injuries. Around a third of admissions for the older age groups are due to deliberate harm (27% of admissions for year olds and 36% of admissions for year olds). (Figure 13) Unintentional injury admissions Falls are the main cause of accidental injury admission across all age groups, districts and boroughs for persons aged under 18 years. At an East Sussex level, for persons aged years falls (30%) make up around a third of unintentional injury admissions, with transport accidents (31%) another third (Figure 14). Tables 5 to 8 show the cause of unintentional admissions by district and borough for the three year period 2010/11 to 2012/ P a g e

18 Exposure to inanimate mechanical forces includes causes such as crushing, contact with sharp glass and being struck by other non-living objects. Exposure to animate mechanical forces includes causes such as animal bites or striking against or bumped into by another person. Other accidental injuries include burns and scalds. Figure 14: cause of unintentional injury admissions by age group, 2010/11 to 2012/13 Table 5: 0-4 year olds, unintentional injury admissions, 2010/11 to 2012/13 Number of admissions, 0-4 year olds Eastbourne Hastings Lewes Rother Wealden Total Falls Exposure to inanimate mechanical forces Accidental poisoning by and exposure to noxious substances Transport accidents <5 < Exposure to animate mechanical forces 13 8 <5 < Others Total Percentage of admissions, 0-4 year olds Eastbourne Hastings Lewes Rother Wealden Total Falls 56% 57% 61% 54% 55% 56% Exposure to inanimate mechanical forces 14% 14% 18% 15% 17% 15% Accidental poisoning by and exposure to noxious substances 10% 13% 8% 16% 11% 12% Transport accidents 5% 3% - - 4% 3% Exposure to animate mechanical forces 5% 2% - - 5% 3% Others 9% 11% 9% 12% 8% 10% Total 100% 100% 100% 100% 100% 100% 18 P a g e

19 For children aged 0-4 years the percentage of unintentional injury admissions caused by a fall ranges from 54% in Rother to 61% in Lewes. Around 1 in 10 admissions are due to accidental poisoning with the lowest percentage in Lewes (8%) and the highest percentage in Rother (16%). Table 6: 5-11 year olds, unintentional injury admissions, 2010/11 to 2012/13 Number of admissions, 5-11 year olds Eastbourne Hastings Lewes Rother Wealden Total Falls Exposure to inanimate mechanical forces Accidental poisoning by and exposure to noxious substances <5 <5 <5 <5 0 7 Transport accidents Exposure to animate mechanical forces <10 <10 <10 < Others Total Percentage of admissions, 5-11 year olds Eastbourne Hastings Lewes Rother Wealden Total Falls 70% 67% 66% 56% 61% 64% Exposure to inanimate mechanical forces 8% 11% 11% 12% 12% 11% Accidental poisoning by and exposure to noxious substances % 1% Transport accidents 11% 10% 10% 17% 13% 12% Exposure to animate mechanical forces % 6% Others 6% 6% 7% 9% 6% 7% Total 100% 100% 100% 100% 100% 100% For children aged 5-11 years the percentage of unintentional injury admissions caused by a fall ranges from 56% in Rother to 70% in Eastbourne. Around 1 in 10 admissions were caused by exposure to inanimate mechanical forces and around 1 in 10 were due to transport accidents. Table 7: year olds, unintentional injury admissions, 2010/11 to 2012/13 Number of admissions, year olds Eastbourne Hastings Lewes Rother Wealden Total Falls Exposure to inanimate mechanical forces Accidental poisoning by and exposure to noxious substances <5 7 <5 <5 <5 19 Transport accidents Exposure to animate mechanical forces Others >10 12 >10 >10 >10 62 Total Percentage of admissions, year olds Eastbourne Hastings Lewes Rother Wealden Total Falls 42% 44% 49% 38% 37% 42% Exposure to inanimate mechanical forces 11% 16% 12% 14% 11% 13% Accidental poisoning by and exposure to noxious substances - 4% % Transport accidents 24% 22% 25% 32% 30% 27% Exposure to animate mechanical forces 13% 6% 7% 6% 12% 9% Others - 7% % Total 100% 100% 100% 100% 100% 100% Around 1 in 5 unintentional injury admissions for young people aged years in Hastings were due to transport injuries with this rising to around 1 in 3 in Rother. 19 P a g e

20 Table 8: year olds, unintentional injury admissions, 2010/11 to 2012/13 Number of admissions, year olds Eastbourne Hastings Lewes Rother Wealden Total Falls Exposure to inanimate mechanical forces Accidental poisoning by and exposure to noxious substances Transport accidents Exposure to animate mechanical forces Others Total Percentage of admissions, year olds Eastbourne Hastings Lewes Rother Wealden Total Falls 43% 27% 24% 33% 25% 30% Exposure to inanimate mechanical forces 11% 19% 21% 14% 18% 16% Accidental poisoning by and exposure to noxious substances 4% 6% 10% 5% 4% 5% Transport accidents 25% 28% 29% 30% 38% 31% Exposure to animate mechanical forces 8% 8% 9% 11% 7% 8% Others 9% 12% 7% 8% 8% 9% Total 100% 100% 100% 100% 100% 100% 1 in 4 unintentional injury admissions for young people aged years in Eastbourne were due to transport injuries with this rising to around 2 in 5 in Wealden. Deliberate injury admissions Admissions due to deliberate harm injuries are either caused by self-harm or assault. The majority (90%) of deliberate harm injury admissions for young people aged years are due to self-harm, with 79% of admissions for year olds due to self-harm. 89% of self-harm admissions (for both age groups together) are due to self-poisoning (excluding alcohol) and 7% of self-harm admissions are due to self-harm by a sharp object. At an East Sussex level, 77% of assault admissions for young people aged years are from assaults due to bodily force, 10% from assault by sharp object and 8% from assault by a blunt object. Table 9: year olds, deliberate harm injury admissions, 2010/11 to 2012/13 Number of admissions, deliberate harm, year olds Eastbourne Hastings Lewes Rother Wealden Total Self- harm Assault Total Percentage of admissions, year olds Eastbourne Hastings Lewes Rother Wealden Total Self-harm 78% 92% 90% 91% 94% 90% Assault 22% 8% 10% 9% 6% 10% Total 100% 100% 100% 100% 100% 100% For young people aged years, the percentage of deliberate harm injury admissions that have been caused by assault range from 6% in Wealden to 22% in Eastbourne. Table 10: year olds, deliberate harm injury admissions, 2010/11 to 2012/13 Number of admissions, deliberate harm, year olds Eastbourne Hastings Lewes Rother Wealden Total Self-harm Assault Total Percentage of admissions, year olds Eastbourne Hastings Lewes Rother Wealden Total Self-harm 77% 74% 80% 82% 82% 79% Assault 23% 26% 20% 18% 18% 21% Total 100% 100% 100% 100% 100% 100% For young people aged years, the percentage of deliberate harm injury admissions that have been caused by assault range from 18% in Rother and Wealden to 26% in Hastings. 20 P a g e

21 Transport accident admissions Figure 15 shows the type of transport accident resulting in hospital admission by age group. For children aged 0-4 years there were 38 transport accident admissions during 2010/11 to 2012/13, of which 17 were children injured as pedestrians. Due to the smaller numbers of admissions for this age group they are not included in the figure below. Around half of transport admissions for children aged 5-11 years are due to cycling accidents and a quarter due to pedestrian accidents. For young people aged years around two-thirds of transport admissions are caused by car or motorcycle accidents. Figure 15: cause of transport admissions by age group, 2010/11 to 2012/13 From 2010/11 to 2012/13 there has been a 31% decrease in the number of hospital admissions due to cycling accidents for persons aged 5-24 years in East Sussex (decrease in number of 22 admissions). (Table 11) Table 11: number of cycling accident hospital admissions by age group and year, 2010/11 to 2012/13 (note admissions for 0-4 year olds are excluded due to small numbers) Year 5-11 years years years Total 2010/ / / Total P a g e

22 The rate of cycling accident hospital admissions during the three year period 2010/11 to 2012/13 is highest in Rother for 5-11 year olds and year olds, and highest in Wealden for year olds (note that these rates are based on small numbers, and differences in the rates between areas are not significantly different). Table 12: rate of cycling accident hospital admissions by age group and local authority (per 10,000 population), 2010/11 to 2012/13 (note admissions for 0-4 year olds are excluded due to small numbers) Local Authority 5-11 years years years Eastbourne Hastings Lewes Rother Wealden P a g e

23 Falls admissions For children aged 0-4 years and 5-11 years falls are the cause of over half of accident admissions. These admissions are broken down further to understand more about the fall incidents that resulted in a hospital admission. 73% of falls for children aged 0-4 years occurred in the home with 1 in 5 of these (19%) a fall on/from stairs/steps. Falls involving a bed were the next main type of fall that occurred in the home (17%). Of falls that occurred outside the home, a quarter (25%) of these were a fall involving playground equipment. Table 13: type and place of fall for children aged 0-4 years, 2010/11 to 2012/13 Falls for children aged 0-4 years, 2010/11 to 2012/13 Place of occurrence (n) Place of occurrence (%) Type of fall Home Elsewhere Home Elsewhere Fall on and from stairs and steps % 6% Fall involving bed 82 <5 17% - Fall involving other furniture % 6% Fall on same level from slipping tripping and stumbling % 18% Fall involving chair % 6% Fall involving playground equipment % 25% Fall while being carried or supported by other persons % 10% Other fall on same level % 7% Unspecified fall % 6% Other fall from one level to another 15 <5 3% - Oth fall same level due collision/pushing by another person 6 5 1% 3% Fall from out of or through building or structure 7 <5 1% - Fall involving ice-skates skis roller-skates or skateboards 5 5 1% 3% Fall from tree <5 <5 - - Fall on and from ladder <5 <5 - - Fall involving wheelchair <5 <5 - - Grand Total % 100% A quarter (25%) of falls for children aged 5-11 years occurred in the home, with around 1 in 5 (18%) at school or another public administration area. 1 in 10 (9%) falls occurred at a sports or athletics area. Table 14: type and place of fall for children aged 5-11 years, 2010/11 to 2012/13 Falls for children aged 5-11 years, 2010/11 to 2012/13 Place of occurrence (n) Place of occurrence (%) Type of fall Home School (& other public admin areas) Sports & athletics area Elsewhere Home School (& other public admin areas) Sports & athletics area Elsewhere Fall involving playground equipment % 17% 17% 35% Fall on same level from slipping tripping and stumbling % 36% 26% 10% Fall on and from stairs and steps 20 <5 <5 8 13% - - 3% Other fall from one level to another 15 <5 < % - - 9% Fall involving other furniture 11 <5 <5 <5 7% Other fall on same level % 13% 19% 9% Unspecified fall <5 16 7% 11% - 6% Fall involving bed % 0% 0% 0% Fall involving chair 7 7 <5 <5 5% 6% - - Fall from out of or through building or structure <5 <5 < % Fall on and from ladder <5 <5 <5 < Fall involving ice-skates skis roller-skates or skateboards <5 < % 12% Fall from tree <5 <5 < % Oth fall same level due collision/pushing by another person <5 8 9 <5-7% 17% - Fall while being carried or supported by other persons <5 <5 <5 < Fall on same level involving ice and snow <5 <5 <5 < Fall on and from scaffolding <5 <5 <5 < Fall from cliff <5 <5 <5 < Grand Total % 100% 100% 100% 23 P a g e

24 A&E attendances due to injuries, 2012/13 For children and young people aged under 25 years, there were 22,000 A&E attendances due to injuries (Table 15). Eastbourne and Hastings have the highest rates for both children aged 0-4 years and 5-11 years, and these are significantly higher rates compared to East Sussex. Lewes and Wealden districts have significantly lower rates than East Sussex for children aged 0-4 years. (Figure 16) Table 15: number of injury A&E attendances by age group and local authority, 2012/13 Eastbourne Hastings Lewes Rother Wealden East Sussex 0-4 years years years years Grand Total Figure 16: rate of A&E injury attendances for 0-4 year olds and 5-11 years by local authority, 2012/13 24 P a g e

25 The rate of A&E injury attendances for 0-4 year olds varies by children s centre with the highest rate in Red Lake and the lowest in Lewes. Figure 17: rate of A&E injury attendances for 0-4 year olds by children s centre, 2012/13 Hastings has the highest rate for young people aged years and a significantly higher rate than the rest of East Sussex. For young people aged years and years Lewes has significantly lower A&E injury attendance rates than all other East Sussex district and boroughs. (Figure 18) 25 P a g e

26 Figure 18: rate of A&E injury attendances for year olds and years by local authority, 2012/13 Other accident makes up the majority of causes of A&E injury attendances across all age groups. 1 in 5 (20%) attendances for people aged years and 1 in 10 (10%) for people aged years are due to sports injuries. More than 1 in 10 attendances for year olds are due to deliberate injuries (assault 6% and self-harm 6%). Figure 19: reason for attendance (national A&E codes) by age group, 2012/13 26 P a g e

27 To further understand other accident attendances, the diagnosis code has been used (using national A&E dataset diagnosis codes) and Figures 20 to 23 show the diagnoses by age group. It is important to note that a number of these attendances don t have a classifiable diagnosis or have missing diagnosis data. A quarter (24%) of other accident attendances for 0-4 year olds are due to head injuries. Dislocation/fracture/joint injury/amputation is the largest cause of other accidents for the older age groups. Figure 20: diagnosis of other accident injury attendances for children aged 0-4 years, 2012/13 Figure 21: diagnosis of other accident injury attendances for children aged 5-11 years, 2012/13 27 P a g e

28 Figure 22: diagnosis of other accident injury attendances for young people aged years, 2012/13 Figure 23: diagnosis of other accident injury attendances for young people aged years, 2012/13 28 P a g e

29 Hastings has the highest rate for 0-4 year olds of other accident attendances with a diagnosis of head injury, and a significantly higher rate than Lewes, Rother and Wealden districts. (Figure 24) Figure 24: head injuries for children age 0-4 years by local authority, 2012/13 For persons aged 0-4 years, almost three-quarters of other accidents occurred at home. A quarter of other accidents for those aged 5-11 years and years occurred at an educational establishment. (Figure 25) Figure 25: place of occurrence of other accident, by age group, 2012/13 29 P a g e

30 A&E attendances due to road traffic accidents A&E attendances for injuries caused by road traffic accidents are highest in the years age group. The rate of attendances for this age group are highest in Rother and Wealden, with the only significant difference at a district and borough level being that Lewes has a significantly lower rate than Wealden. Table 16: A&E attendances due to road traffic accidents by age group and local authority, 2012/13 Eastbourne Hastings Lewes Rother Wealden East Sussex 0-4 years years years years Grand Total Figure 26: road traffic accident attendances for young people aged years by local authority, 2012/13 30 P a g e

31 A&E attendances due to assaults The majority (72%) of attendances due to assaults are for males, with the highest numbers of attendances for persons aged years. (Figure 27) Figure 27: age and sex breakdown of A&E attendances due to assaults, 2012/13 The rate of A&E attendances due to assaults for young people aged years is highest in Eastbourne and lowest in Wealden. (Figure28) Figure 28: assault attendances for young people aged years by local authority, 2012/13 31 P a g e

32 A&E attendances due to self-harm 60% of A&E attendances due to self-harm are for females. By single year of age, the number of attendances tends to be highest for 17 to 19 year olds. (Table 17) Table 17: A&E attendances due assaults by age and sex, 2012/13 Under Grand Total Male Female All persons Eastbourne has the highest rate of A&E attendances due to self-harm for young people aged years and years, with the rate for year olds significantly higher than for the rest of East Sussex. Figure 29: self-harm attendances for young people aged years and years by local authority, 2012/13 Across all ages, 39% of self harm attendances have a diagnosis of poisoning (including overdose), 25% a diagnosis of psychiatric conditions and 8% lacerations. 17% had a diagnosis not classifiable or missing. 32 P a g e

33 Outcome of A&E attendances Figure 30: outcome of A&E attendances by age group and local authority, 2012/13 Other* includes transfer to other health care provider, left department before being seen for treatment, refused treatment, referred to other health care professional or died in department. Around half of attendances for children age 0-4 years and 5-11 years end in discharge, with no further treatment required. For young people aged years and years around 40% of attendances resulted in discharge with no further treatment needed. Attendances resulting in an admission were highest for children aged 0-4 years (7%) and referrals to fracture clinic were highest for year olds (20%). Clare Brown Public Health Information Specialist May P a g e

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