21 st november 2007 maryann hardy university of bradford accidental injury in primary school-aged...
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21st November 2007
Maryann HardyUniversity of Bradford
Accidental Injury in Primary School-Aged Children
Maryann HardySenior Lecturer
University of Bradford
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21st November 2007
Maryann HardyUniversity 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.
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21st November 2007
Maryann HardyUniversity 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
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21st November 2007
Maryann HardyUniversity 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 (1st April 2004 – 31st March 2005)– based on PHIS recommendations
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21st November 2007
Maryann HardyUniversity 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 wards 61 547– Craven wards 5 321– Pendle wards 2 982
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21st November 2007
Maryann HardyUniversity 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%)
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21st November 2007
Maryann HardyUniversity of Bradford
Data Collection
• Age
• Sex
• Postcode• Ward of habitation• SES calculation
• Ethnicity• Self declared• Based on 17 point UK census ethnicity coding tool
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21st November 2007
Maryann HardyUniversity 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.)
Monday 25/7/04 19.00
Keighley Swimming pool
Climbing slide steps
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21st November 2007
Maryann HardyUniversity 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
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21st November 2007
Maryann HardyUniversity 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
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21st November 2007
Maryann HardyUniversity of Bradford
A&E Attendances10140 attendances by 9300 children
Number of attendances
AGH No (%) BRI No (%)
123456
2975 (91.48%) 230 (7.07%) 40 (1.23%) 5 (0.15%) 1 (0.03%) 1 (0.03%)
6325 (91.83%) 481 (6.98%) 70 (1.02%) 10 (0.15%) 2 (0.03%)
0
Total 3 252 6 888
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21st November 2007
Maryann HardyUniversity of Bradford
Child Ethnicity• Data missing 3087 (33.18%)• Declined information 1214 (13.05%)• White British 3905 (41.99%)• Asian 1019 (10.96%)• Other BME 76 (0.82%)
Ethnicity Data
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21st November 2007
Maryann HardyUniversity of Bradford
Ethnic Group AGH no (%)
BRI no (%)
Combined no (%)
White White British White Irish White OtherMixed Heritage White & Black Caribbean White & Black African White & Asian Mixed OtherAsian / Asian British Indian Pakistani Bangladeshi Asian OtherBlack / Black British Caribbean African Black OtherOther Chinese Other ethnic groupData 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)1 (0.03)-4 (0.13) 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)
Total 2975 (100) 6325 (100) 9300 (100)
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21st November 2007
Maryann HardyUniversity of Bradford
Ethnic Group AGH no (%)
BRI no (%)
Combined no (%)
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)
Total 2975 (100) 6325 (100) 9300 (100)
Ethnicity Data
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21st November 2007
Maryann HardyUniversity of Bradford
Ethnic Group AGH no (%)
BRI no (%)
Combined no (%)
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)
Total 2975 (100) 6325 (100) 9300 (100)
Ethnicity Data
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21st November 2007
Maryann HardyUniversity of Bradford
Population Characteristics
Characteristic
White BritishNo (%)n=3905
Asian/Asian British
No (%) n=1019
Age (years) (n =4924)4 – 7 8 – 10 11-12 Gender (n=4924)MaleFemale Socio-economic status (1= least deprived, n=4900)12345Data 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)
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21st November 2007
Maryann HardyUniversity of Bradford
Population Characteristics
Characteristic
White BritishNo (%)n=3905
Asian/Asian British
No (%) n=1019
Age (years) (n =4924)4 – 7 8 – 10 11-12 Gender (n=4924)MaleFemale Socio-economic status (1= least deprived, n=4900)12345Data 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)
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21st November 2007
Maryann HardyUniversity of Bradford
SES Quintiles White BritishNo (%)
AsianNo (%)
AGH
12345
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)
Total 2215 282
BRI
12345
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)
1668 735
Child socio-economic status
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21st November 2007
Maryann HardyUniversity of Bradford
Population Characteristics
Characteristic
White BritishNo (%)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)
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21st November 2007
Maryann HardyUniversity of Bradford
Attendance Wards BRI
Catchment area Attendance area
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21st November 2007
Maryann HardyUniversity of Bradford
Attendance Wards AGH
Catchment area Attendance area
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21st November 2007
Maryann HardyUniversity of Bradford
Ward proportional attendance
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21st November 2007
Maryann HardyUniversity of Bradford
High attendance wardsWard Distance Attendance Proportion (%)
Glusburn (1) 2-5km 88/364 24.2%
Sutton in Craven (1) 2-5km 77/389 19.8%
Heaton (3) 1-2km 450/2404 18.7%
West Craven (1) 10-20km 29/166 17.5%
Keighley West (3) 2-5km 379/2179 17.4%
Thornton (3) 2-5km 254/1530 16.6%
Skipton South (3) 5-10km 78/477 16.4%
Cowling (1) 5-10km 41/251 16.3%
Keighley South (4) 5-10km 296/1847 16.0%
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21st November 2007
Maryann HardyUniversity of Bradford
Ward Distance Attendance Proportion (%)
Glusburn (1) 2-5km 88/364 24.2%
Sutton in Craven (1) 2-5km 77/389 19.8%
Heaton (3) 1-2km 450/2404 18.7%
West Craven (1) 10-20km 29/166 17.5%
Keighley West (3) 2-5km 379/2179 17.4%
Thornton (3) 2-5km 254/1530 16.6%
Skipton South (3) 5-10km 78/477 16.4%
Cowling (1) 5-10km 41/251 16.3%
Keighley South (4) 5-10km 296/1847 16.0%
Baildon (1) 5-10km 102/1524 6.7%
Rombalds (1) 5-10km 121/1733 7.0%
Queensbury (2) 5-10km 205/2131 9.6%
Idle (1) 5-10km 175/1687 10.4%
Wyke (3) 5-10km 219/1932 11.3%
Aire valley & Loth. (1) 2-5km 46/397 11.6%
High attendance wards
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21st November 2007
Maryann HardyUniversity of Bradford
Other WardsWard Distance Attendance Proportion (%)
Bradford Moor (5) 5-10km 423/3473 12.2%
Great Horton (3) 1-2km 313/2269 13.8%
Bowling (5) 5-10km 388/2880 13.5%
University (5) 1-2km 514/3649 14.1%
Little Horton (5) 2-5km 392/2685 14.6%
Undercliffe (4) 2-5km 331/2125 15.6%
Toller (4) <1km 553/3467 15.9%
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21st November 2007
Maryann HardyUniversity of Bradford
Analysis
• Activity at time of injury
• Mechanism of injury
• Injury diagnosis
• Injured anatomy
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21st November 2007
Maryann HardyUniversity of Bradford
Injury Severity
Injury Severity AGHNo (%)
BRINo (%)
CombinedNo (%)
SevereModerateMinor
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)
Total 3252 6888 10140
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21st November 2007
Maryann HardyUniversity of Bradford
Patient Disposal
Injury Diagnosis AGHNo (%)
BRINo (%)
CombinedNo (%)
AdmittedHospital OPGP follow-upDischargedDiedLeft A&E departmentMissing
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)
Total 3252 6888 10140
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21st November 2007
Maryann HardyUniversity of Bradford
Government priority areas
Injury cause Severe No (%)
ModerateNo (%)
MinorNo (%)
SeverityMissingNo (%)
Total
RTA – pedestrianFire & thermal injuriesDrowningCycling
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
Total 92 (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%
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21st November 2007
Maryann HardyUniversity 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%
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21st November 2007
Maryann HardyUniversity of Bradford
Severe injuriesWard Study proportion Proportion 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%
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21st November 2007
Maryann HardyUniversity of Bradford
Severe injuriesWard (SES) Study proportion Proportion 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%
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21st November 2007
Maryann HardyUniversity of Bradford
FracturesWard Study proportion Proportion 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%
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21st November 2007
Maryann HardyUniversity of Bradford
Ward Study proportion Proportion 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
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21st November 2007
Maryann HardyUniversity of Bradford
Pedestrian RTAWard Study proportion Proportion 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%
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21st November 2007
Maryann HardyUniversity of Bradford
Ward Study proportion Proportion 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
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21st November 2007
Maryann HardyUniversity of Bradford
Vehicle Passenger RTAWard Study proportion Proportion 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%
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21st November 2007
Maryann HardyUniversity of Bradford
Ward Study proportion Proportion 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
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21st November 2007
Maryann HardyUniversity of Bradford
School attendancesWard Study proportion Proportion 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%
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21st November 2007
Maryann HardyUniversity of Bradford
Ward Study proportion Proportion 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 South 22 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
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21st November 2007
Maryann HardyUniversity 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
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21st November 2007
Maryann HardyUniversity 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
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21st November 2007
Maryann HardyUniversity 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
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21st November 2007
Maryann HardyUniversity 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?