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Amputee Statistical Database for the United Kingdom : 2004/05 Report �

Information Services DivisionNHSScotland

on behalf of

National Amputee Statistical Database (NASDAB)

Edinburgh 2005

The Amputee Statistical Database for the United Kingdom

2004/05

2 Amputee Statistical Database for the UK : 2004/05 Report

© Common Services Agency/Crown Copyright 2005

Brief extracts from this publication may be reproduced provided the source is fully acknowledged. Proposals for the reproduction of large extracts should be addressed to :

ISD Publications, Gyle Square,1 South Gyle Crescent, Edinburgh, EH12 9EB.

Information Services is the database manager for the National Amputee Statistical Database (NASDAB)

Information Services NHSScotlandGyle Square1 South Gyle CrescentEdinburgh EH12 9EB

Tel 0131-275-7777

Publication enquiries and orders :Jane JamesBusiness ManagerGyle Square1 South Gyle CrescentEdinburgh EH12 9EB

Tel 0131-275-6421email [email protected]

Bowley Close NHS Trust Rehabilitation CentreDr Robin LuffBowley CloseFarquhar RoadLondonSE19 1SZ

Tel 0207 346 5232email [email protected]

Designed and typeset by ISD Scotland Publications

Amputee Statistical Database for the United Kingdom : 2004/05 Report �

Contents

Current membership of the NASDAB steering group.............................................................................. 4

Introduction................................................................................................................................................................... 5

UK Prosthetics Services : New Referrals Table 1 Newreferralstoprostheticsservicecentres:2004/05...................................................................................... 8Chart 1 NumberofnewreferralsperyearbygenderApril1997toMarch2005........................................................... 9Table 2 Genderandage;byprostheticservicecentre:2004/05.................................................................................. 10Chart2a Percentageofnewreferralsbyage:2004/05................................................................................................ 12Chart2b Numberofnewreferralsbyageandgender:2004/05................................................................................... 12Chart 2c Percentageofnewreferralsbyageandgender:2004/05............................................................................ 12Chart 2d NumberofnewreferralsbyageandyearApril1997toMarch2005............................................................. 13Chart 2e NumberofnewmalereferralsbyageandyearApril1997toMarch2005.................................................... 13Chart 2f NumberofnewfemalereferralsbyageandyearApril1997toMarch2005................................................. 13Table 3 Levelofamputationandcongenitalabsence;byprostheticsservicecentre:2004/05................................. 14Chart 3a NumberoftotalandlowerlimbamputationsbyyearApril1997toMarch2005............................................. 16Chart 3b NumberofupperlimbandmiscellaneousamputationsbyyearApril1997toMarch2005............................. 16Table 4 Timeintervalfromamputationtoreceiptofreferralbyprostheticsservicecentre:2004/05.......................... 17Chart4a Timeinterval(weeks)betweendateofamputationandreceiptofreferralbyyearApril1997toMarch200518Chart4b Timeinterval(>3months)betweendateofamputationandreceiptofreferral:2004/05............................... 19Chart4c Timeinterval(>3months)betweendateofamputationandreceiptofreferralbyyear April1997toMarch2005................................................................................................................................ 19

UK Prosthetics Services : Upper Limb AmputationsTable 5 Levelofamputationasapercentageoftotalnumber;byprostheticsservicecentre:2004/05..................... 22Table 6 Levelofamputation;bygenderandage:2004/05......................................................................................... 23Chart 6 Levelofamputation:2004/05......................................................................................................................... 23Table 7 Levelofamputation;bycauseofamputation:2004/05.................................................................................. 24Chart 7 NumberofupperlimbamputationbycauseandyearApril1997toMarch2005............................................ 25Table 8 Causeofamputation;byage:2004/05.......................................................................................................... 26Chart 8 Causeofamputation:2004/05including'Nocauseprovided'........................................................................ 26UK Prosthetics Services : Lower Limb AmputationsTable 9 Levelofamputationasapercentageoftotalnumber;byprostheticsservicecentre:2004/05..................... 28Chart 9a NumberoflowerlevelamputationsbylevelandyearApril1997toMarch2005............................................ 29Chart 9b Numberoflowerlevelamputationsbylevelandyear(excludingtrans-femoralandtrans-tibial) April1997toMarch2005................................................................................................................................ 29Table 10 Levelofamputation;bygenderandage:2004/05......................................................................................... 30Chart 10 Levelofamputation:2004/05......................................................................................................................... 30Table 11 Levelofamputation;bycauseofamputation:2004/05.................................................................................. 31Chart 11 NumberoflowerlimbamputationsbycauseandyearApril1997toMarch2005.......................................... 32Table 12 Causeofamputation;byage:2004/05.......................................................................................................... 33Chart 12 Causeofamputation:2004/05including'Nocauseprovided'........................................................................ 33UK Prosthetics Services : MiscellaneousTable 13 Multipleamputationbycauseofamputation,genderandage:2004/05........................................................ 36Chart 13 NumberofmultipleamputationsbyyearApril1997toMarch2005................................................................ 36Table 14 Congenitalabsence;byprostheticsservicecentre,genderandage:2004/05.............................................. 37Chart 14 NumberofcongenitalabsencesbygenderandyearApril1997toMarch2005............................................. 38Additional InformationTable 15 UKupperandlowerprimaryamputations2004/05........................................................................................ 40Chart15a Numberofreferralsagedunder16byagegroupandyearApril1997toMarch2005................................... 41Table15b Percentageofreferralsagedunder16byagegroup:April1997toMarch2005........................................... 41Chart 16 Numberofnewreferralsfollowingamputationasaresultofdysvascularity:April1997toMarch2005........ 42

APPeNDICeS1 MinimumDatasetFields............................................................................................................................................. 462 ListofLevelandCauseofAmputationCodes............................................................................................................. 473 ListofProstheticsServiceCentresSubmittingData................................................................................................... 48LinktodatainExcel.

http://www.nasdab.co.uk/xls.pl?file=nasdab/file/200405_tables.xls


Current membership of the NASDAB steering group

Dr Robin Luff, Bowley Close NHS Trust Rehabilitation Centre (Chairperson)

Mr Angus Berthinussen, British Association of Prosthetists and OrthotistsMrs Joan Forrest, ISD ScotlandMrs Jane James, ISD Scotland (Secretariat) Dr Stephen Kirker, Addenbrookes Prosthetics Service CentreDr Jeff Lindsay, West Midlands Regional Rehabilitation Centre Ms Juliet Pollard, NHS Purchasing and Supply AgencyMs Margaret Roberts, Wrexham Artificial Limb and Appliance CentreMs Sue Walker, Stanmore Disablement Services Centre Mr Simon Webster, British Healthcare Trades Association Professor Alastair Weir, West of Scotland Mobility and Rehabilitation CentreMrs Anne White, Luton and Dunstable Limb Fitting Centre

Amputee Statistical Database for the United Kingdom : 2004/05 Report 5

Introduction

This is the eighth in a series of Annual Reports based on the data provided from the 44 prosthetics service centres in the United Kingdom. The publication presents information on new referrals to prosthetics service centres from �st April 2004 to ��st March 2005. This report provides age and gender profiles of amputees referred to prosthetic centres, as well as level and cause of amputation and national trend information. Trend activity by centre is available on the NASDAB website (www.nasdab.co.uk)

Points of interest

During the period �st April 2004 to ��st March 2005 there were a total of 52�9 new referrals to prosthetics service centres in England, Northern Ireland, Scotland and Wales. This is slightly more than the number of amputees referred in the previous year (5204).

A total of 290 amputees transferred to a different prosthetics service centre during 2004/05. These amputees are not regarded as new referrals to centres and are thus not included in the tables within this publication. It should be noted that � centres – London’s Charing Cross, Portsmouth and Sheffield - were not able to identify transfers separately from new referrals and therefore a very small number of referrals attributed to these centres may be transfers.

Sixty-six per cent of referrals to prosthetic centres are made within a month of the date of amputation.

The gender breakdown of new referrals is similar to previous years. In 2004/05 female referrals account for just over thirty per cent of all new referrals to prosthetics service centres.

Males present at prosthetics service centres at an earlier age than women. The national median age of referrals for males is 65 and for females it is 69 years of age. This is similar to previous years.

Over half of all amputees referred to prosthetic centres are aged over 65 and more than one quarter are aged over 75. Looking at males and females separately, 25 per cent of all male referrals fall within the 75 and over age group compared to �9 per cent of all females.

Referrals following lower limb amputation account for 9� per cent of all amputees referred to prosthetics centres. Those patients referred following an upper limb amputation represent 5 per cent and congenital absence cases account for � per cent of referrals.

The most common level of amputation for referrals continues to be at the trans-tibial level accounting for almost half of all referrals. Trans-femoral amputees make up over a third of referrals to prosthetics centres.

Dysvascularity is the most common reason for referral following a lower limb amputation, accounting for 77 per cent of all lower limb referrals. Diabetes currently accounts for 42 per cent of these referrals. The number of referrals where diabetes is recorded as the cause of amputation has risen significantly over the last 8 years.

Six out of ten patients referred following a lower limb amputation are aged 65 or over and of these two thirds are male.

Almost half of all upper limb referrals are following trans-humeral or trans-radial amputations. Partial hand and upper digit amputees account for 40 per cent of upper referrals.

Upper limb referrals tend to be in the younger age groups reflecting the aetiology of the condition (mainly trauma). Sixty-six per cent of all upper limb referrals were aged less than 55 years.

Data on Ethnic origin was collected for the second year using the new National standard codes issued by the NHS Information Authority in April 200�. There is still considerable variation between centres in the quality of the data submitted and it has been decided not to publish data this year. However we will continue to collect this data, monitoring completeness and quality, with the hope that in future years we will be able to include information on ethnic origin in the annual report.

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UK Prosthetics Services

New RefeRRAlS


New referrals

The table below shows the total number of referrals to each of the UK’s prosthetics service centres for the four quarters ending ��st March 2005. The number of amputees referred to prosthetic centres (52�9) across the UK is similar to the number reported last year (5204).

The number of new referrals seen by centres varies enormously, probably reflecting the size of their catchment population. For example, �� amputees were referred to the centre in Birmingham compared to 24 in Carlisle. This has implications for the size of the service required and costs required to run these centres.

1 New referrals to prosthetics service centres : 2004/05

Quarter ending Total No.referrals

Total No. referrals

Prosthetics Service Centre �0 June 2004 �0 Sept 2004 �� Dec 2004 �� March 2005 2004/05 200�/04

Aberdeen �7 �8 �6 20 71 4�Belfast �8 22 �0 22 92 92Birmingham 92 89 75 55 311 �09Bristol �0 �0 �2 �� 123 ��0Cambridge 2� 20 �5 �7 93 89Cardiff 49 �9 5� �0 169 ��9Carlisle 8 5 2 9 24 ��Cleveland 28 24 29 �4 115 �09Derby �8 �7 �6 22 73 54Dorset �5 2� �9 20 97 87Dundee �0 24 22 �5 91 �0�Edinburgh �4 �6 24 �9 73 82Exeter �9 29 28 �4 130 �47Gillingham 29 47 �9 �6 151 �9��

Glasgow (Strathclyde University) 8 5 7 4 24 �0Glasgow (Westmarc) 77 70 56 65 268 2��Hull �5 20 �9 �9 73 89Inverness 4 �� 6 8 29 �6Isle of Wight� � 7 � 2 15 �5Leeds2 5� 56 4� 5� 203 20�Leicester 8 �4 8 8 38 47�

Liverpool (Fazakerley) 28 45 28 27 128 �6�London (Bowley Close)2 �5 �6 �6 8 55 55London (Charing Cross) 29 2� 24 24 98 724

London (Harold Wood) 49 64 5� 52 216 242London (Roehampton) 20 25 �8 22 85 �02London (Stanmore) �� 9 �9 �8 147 �66Luton & Dunstable 22 2� 20 28 93 84Manchester 7� 88 7� 6� 293 285Newcastle �5 45 �8 �9 157 �76Northampton �7 �8 �4 �5 64 64Norwich 25 24 29 25 103 �0�Nottingham 44 46 42 �4 166 �68Oxford �0 �7 �2 �9 118 �05Plymouth 25 2� �5 �2 115 89Portsmouth 25 28 �2 20 85 99Preston 52 �8 �5 �2 157 �4�Sheffield 56 52 6� 57 228 2�0Stoke �0 �� 25 24 110 �26Sussex �� 2� 2� 40 113 �07Swansea �� 42 24 �5 132 �24Wirral �2 20 �8 28 98 �02Wolverhampton �7 �0 �2 40 139 ��9Wrexham 2� 24 �� 8 76 67

All centres 1 354 1 386 1 260 1 239 5 239 5 204

� 2000/0� data. 2 200�/04 data. � 2002/0� data. 4 200�/02 data.

Referrals to UK Prosthetics ServicesTa

ble

� 2002/0� data.2 2000/0� data.

Aberdeen �7 �8 �6 20 71 4�Belfast �8 22 �0 22 92 92Birmingham 92 89 75 55 311 �09Bristol �0 �0 �2 �� 123 ��0Cambridge 2� 20 �5 �7 93 89Cardiff 49 �9 5� �0 169 ��9Carlisle 8 5 2 9 24 ��Cleveland 28 24 29 �4 115 �09Derby �8 �7 �6 22 73 54Dorset �5 2� �9 20 97 87Dundee �0 24 22 �5 91 �0�Edinburgh �4 �6 24 �9 73 82Exeter �9 29 28 �4 130 �47Gillingham 29 47 �9 �6 151 �9��

Glasgow (Strathclyde University) 8 5 7 4 24 �0Glasgow (Westmarc) 77 70 56 65 268 2��Hull �5 20 �9 �9 73 89Inverness 4 �� 6 8 29 �6Isle of Wight� � 7 � 2 15 �5Leeds2 5� 56 4� 5� 203 20�Leicester 8 �4 8 8 38 47�

Liverpool (Fazakerley) 28 45 28 27 128 �6�London (Bowley Close)2 �5 �6 �6 8 55 55London (Charing Cross) 29 2� 24 24 98 724

London (Harold Wood) 49 64 5� 52 216 242London (Roehampton) 20 25 �8 22 85 �02London (Stanmore) �� 9 �9 �8 147 �66Luton & Dunstable 22 2� 20 28 93 84Manchester 7� 88 7� 6� 293 285Newcastle �5 45 �8 �9 157 �76Northampton �7 �8 �4 �5 64 64Norwich 25 24 29 25 103 �0�Nottingham 44 46 42 �4 166 �68Oxford �0 �7 �2 �9 118 �05Plymouth 25 2� �5 �2 115 89Portsmouth 25 28 �2 20 85 99Preston 52 �8 �5 �2 157 �4�Sheffield 56 52 6� 57 228 2�0Stoke �0 �� 25 24 110 ��2Sussex �� 2� 2� 40 113 �07Swansea �� 42 24 �5 132 �24Wirral �2 20 �8 28 98 �02Wolverhampton �7 �0 �2 40 139 ��9Wrexham 2� 24 �� 8 76 67

��All centres 1 354 1 386 1 260 1 239 5 239 4 900


Referrals to UK Prosthetics Services

Cha

rt 1 Number of new referrals per year by gender April 1997 to March 2005

There has been a fairly consistent pattern over the past eight years in new referrals to prosthetic centres. The gender split between patients is constant over time with approximately one-third of all new referrals being female.

Note: All includes referrals where gender is not specified.

1000

2000

3000

4000

5000

6000

7000

2004/05 2003/04 2002/03 2001/02 2000/01 1999/00 1998/99 1997/98

All 5862 5661 5451 5765 5724 5713 5204 5239

Male 3793 3764 3667 3842 3868 3840 3582 3603

Female 1846 1870 1717 1856 1848 1863 1618 1634

1000

2000

3000

4000

5000

6000

7000

Num

ber

�0 Amputee Statistical Database for the UK : 2004/05 Report


Gender and age

Overall there are slight variations for the median age ranging from 6�-74 years. Edinburgh, Glasgow Strathclyde and London Bowley Close (200�/04 data) have the highest percentage of younger patients, with � in every 5 patients being less than 65 years old. Plymouth has the highest median age of 74 and Edinburgh and Hull have the lowest (6�), with over half of all new referrals aged under 65.

2 Gender and age; by prosthetics service centre : 2004/05

Males

Prosthetics Service less �6-54 55-64 65-74 75 and All MedianCentre than �6 over ages age

Aberdeen - �0 �0 �9 5 44 66Belfast � �6 7 �5 7 48 62Birmingham 7 5� 46 49 54 209 64Bristol � 2� �4 �8 �0 84 67Cambridge - �6 �6 �2 �7 61 62Cardiff � 29 25 �� 4 122 67Carlisle - - 7 5 4 16 67Cleveland 2 26 �9 �7 2� 85 6�Derby � 4 9 �5 �6 45 7�Dorset 2 �� 7 �8 61 67Dundee - 9 �� 2� 24 69 68Edinburgh 2 �7 9 9 �0 47 60Exeter � �8 �7 �0 �0 96 69Gillingham 4 �0 2� 25 26 106 62Glasgow (Strathclyde University) - 5 6 � � 15 62Glasgow (Westmarc) 5 40 4� 60 �5 183 65Hull - 20 �0 �4 9 53 6�Inverness - 4 � 7 6 20 70Isle of Wight� - 2 � 5 2 12 66Leeds2 6 42 24 44 29 145 65Leicester � 6 9 6 7 29 6�Liverpool (Fazakerley) � �2 �7 26 25 83 68London (Bowley Close)2 � �2 �7 6 6 42 6�London (Charing Cross) - �8 �2 2� �4 65 66London (Harold Wood) 4 57 24 �2 �2 149 6�London (Roehampton) � 27 �0 �0 �� 59 56London (Stanmore) 5 27 �6 28 �7 93 64Luton & Dunstable - �� 2 �� 28 66 70Manchester 4 42 5� 55 49 203 66Newcastle 4 24 26 �� 24 111 65Northampton � 6 �� 2 �4 46 68Norwich 2 20 �4 �7 �8 71 64Nottingham 6 �� 0 27 �9 113 60Oxford 4 2� �8 25 �� 83 62Plymouth 2 �2 9 24 �8 85 74Portsmouth 4 �4 �5 9 �� 55 62Preston � 27 29 27 25 109 64Sheffield 6 48 �4 �8 �2 158 62Stoke � 9 �7 �7 �0 74 7�Sussex - �5 �5 �8 22 70 68Swansea 2 �8 �6 �0 29 95 68Wirral - �4 �0 2� �9 66 68Wolverhampton - �6 22 �9 22 99 68Wrexham � 9 �� 8 �9 58 70

All centres 90 875 762 972 904 3 603 65

Tabl

e

� 2000/0� data.2 200�/04 data.

Amputee Statistical Database for the United Kingdom : 2004/05 Report ��


There is a marked gender difference in median age at presentation, with males tending to present at a younger age. The median age for males is 65 and for females it is 69 years of age. At an individual centre level median age varies from 56 to 74 for males and 60 to 79 for females. There are eight centres within the UK where the female median age is lower than the male. These are Bristol, Cardiff, Leeds, Leicester, Liverpool, London Stanmore, Swansea and Wrexham.

One quarter of males and almost two fifths of females were aged 75 or over at the time of referral.

Females Gender Total Median

Unspecified All AgeReferrals All

less �6-54 55-64 65-74 75 and All Median Referrals Prosthetics Service than �6 over ages age Centre

� 6 � 7 �2 27 7� - 71 69 Aberdeen2 8 �� 4 9 44 65 - 92 64 Belfast6 20 �7 �� 48 102 7� - 311 65 Birmingham2 7 �0 5 �5 39 65 - 123 66 Bristol� 6 � 7 �7 32 75 - 93 68 Cambridge4 6 9 �5 �� 47 66 - 169 67 Cardiff- 2 � 2 � 8 67 - 24 67 Carlisle- 8 6 5 �� 30 65 - 115 6� Cleveland- � 4 8 �� 28 72 - 73 7� Derby2 5 4 8 �7 36 7� - 97 69 Dorset- 2 � 5 �2 22 75 - 91 69 Dundee� � �4 6 4 26 62 - 73 6� Edinburgh- 7 4 �� 2 34 7� - 130 69 Exeter� 5 6 9 24 45 75 - 151 67 Gillingham2 � � � 4 9 66 - 24 6� Glasgow (Strathclyde University)

� �6 20 2� 25 85 67 - 268 65 Glasgow (Westmarc)

� 6 � 4 6 20 62 - 73 6� Hull- 2 � � 5 9 76 - 29 70 Inverness- � - - 2 3 76 - 15 66 Isle of Wight�

7 �5 9 7 20 58 6� - 203 64 Leeds2

� � � � � 9 6� - 38 6� Leicester� �2 6 9 �7 45 67 - 128 68 Liverpool (Fazakerley)

� 4 � 4 � 13 65 - 55 62 London (Bowley Close)2

- 7 � 4 �8 32 76 � 98 67 London (Charing Cross)

4 �4 �6 7 26 67 64 - 216 6� London (Harold Wood)

� 6 � 8 8 26 70 - 85 6� London (Roehampton)

6 �7 7 �0 �4 54 60 - 147 6� London (Stanmore)

- � 7 � �4 27 75 - 93 7� Luton & Dunstable4 �9 �� 20 �4 90 69 - 293 66 Manchester� �2 7 �� 46 65 - 157 65 Newcastle� � 4 5 7 18 72 - 64 69 Northampton� 7 5 9 �0 32 70 - 103 66 Norwich4 �� 6 20 �0 53 66 - 166 6� Nottingham4 8 6 2 �5 35 62 - 118 62 Oxford� 5 � 7 �4 30 74 - 115 74 Plymouth� 8 � 5 �� 30 72 - 85 64 Portsmouth� 9 5 �4 �9 48 70 - 157 66 Preston2 �7 6 �� 2 70 7� - 228 65 Sheffield- 5 4 5 22 36 79 - 110 7� Stoke2 7 4 8 2� 42 74 � 113 69 Sussex2 5 �� 8 �� 37 65 - 132 67 Swansea� 5 4 7 �5 32 7� - 98 70 Wirral- 4 4 7 25 40 79 - 139 69 Wolverhampton- 6 2 4 6 18 68 - 76 69 Wrexham

76 322 256 338 642 1 634 69 2 5 239 66 All centres


0

200

400

600

800

1000

Females

Males

75 and over65-7455-6416-54less than 16

Cha

rt 2a Percentage of new referrals by age : 2004/05

Cha

rt 2b Number of new referrals by age and gender : 2004/05


75 and over 30%

65 - 74 25%

55 - 64 19%

16 - 54 23%

less than 16 3%

Chart 2b shows the number of new referrals split by age and gender highlighting the difference in number of males and females referred. Within all age groups there are more male than female referrals, with two thirds of all referrals being male.

Chart 2a presents the percentage of new referrals by age. Thirty per cent of all referrals are aged 75 years and over at the time of referral. This chart also highlights the relatively small number of patients aged under �6 (� % of all new referrals). However, the need for support from centres for these patients will extend to a much longer time frame than for other patients.

Cha

rt 2c Percentage of new referrals by age and gender : 2004/05

Chart 2c highlights the difference in age at presentation between males and females, with females tending to be older. Almost 40 per cent of female referrals occur within the 75 and over age group whilst this age group accounts for around one quarter of males. By contrast, almost half of all male referrals were aged less than 65 compared with 40 per cent of females.

0

10

20

30

40

Females

Males

75 and over65-7455-6416-54less than 16

Perc

enta

geN

umbe

r


Cha

rt

There is a fairly consistent pattern between the age groups with the oldest age groups accounting for most of the referrals. The number of referrals within the �6-54 age group has dropped back to previous levels.


0

200

400

600

800

1000

1200

1400

1600

1800

2004/052003/042002/032001/022000/011999/001998/991997/98

Num

ber

0

200

400

600

800

1000

1200

1400

1600

1800

< 16 181 214 209 194 198 160 157 166

16-54 1293 1268 1210 1279 1278 1422 1236 1197

55-64 897 917 962 1006 1016 1000 935 1018

65-74 1583 1534 1477 1558 1519 1491 1337 1310

75+ 1669 1677 1563 1721 1706 1631 1536 1546

Cha

rt 2e Number of new male referrals by age and year April 1997 to March 2005

Charts 2e and 2f show separately by gender the number of referrals over time. Consistently the most common age group for male referrals is 65–74 compared to the over 75 age group for female referrals.

2d Number of new referrals by age and year April 1997 to March 2005

2f Number of new female referrals by age and year April 1997 to March 2005

Cha

rt

0

200

400

600

800

1000

1200

75+

65-74

55-64

16-54

< 16

2004/052003/042002/032001/022000/011999/001998/991997/98

Num

ber

< 16 108 122 119 114 107 88 82 90

16-54 938 897 904 934 919 1038 913 875

55-64 683 699 717 761 779 775 713 762

65-74 1101 1063 1042 1065 1074 1072 972 972

75+ 952 965 878 968 989 929 902 904

73 92 89 80 91 72 75 76 <16

354 371 296 330 359 384 323 322 16-54

214 217 231 238 237 225 222 256 55-64

482 469 425 476 444 419 365 338 65-74

717 711 673 732 717 701 633 642 75+

0

200

400

600

800

1000

1200

2004/052003/042002/032001/022000/011999/001998/991997/98

Num

ber

0

200

400

600

800

1000

1200


3 level of amputation and congenital absence; by prosthetics service centre : 2004/05Tabl

e

� See also the Upper Limb Amputation tables on pages 20-24 for additional details.2 See also the Lower Limb Amputation tables on pages 26-�� for additional details.� See also the Miscellaneous Group of Amputation tables on pages �4-�6 for additional details on complex amputations and congenital absence.4 2000/0� data.5 200�/04 data.6 Derby, London Charing Cross, Luton and Dunstable, Stoke and Wolverhampton do not provide an upper limb service.


level amputation

The completeness in the recording of level of amputation at centres continues to be very good with all records submitted with a level of amputation recorded. Of the 52�9 referrals the great majority (9�%) were referred following a lower limb amputation. Referrals following upper limb amputation account for around 5 per cent and congenital absence of upper and lower limbs account for � per cent of all referrals.

Upper Limb Amputations�

Shoulder Elbow Wrist DoubleProsthetics Service Fore disartic- Trans- disartic- Trans- disartic- Partial Upper upperCentre quarter ulation humeral ulation radial ulation hand Digits amp. Total

Aberdeen - � � - � - 2 2 - 7Belfast - � 2 - � � � - - 8Birmingham - 2 �� - � - - 22 � 39Bristol - - � - 2 - - � - 6Cambridge - - - - � - - - - 1Cardiff - - � - � - 5 - - 9Carlisle - - - - - - - - - -Cleveland � - - - - - - � - 4Derby6 - - - - - - - - - -Dorset 2 - � - � - � - - 5Dundee - - 2 - - - - - - 2Edinburgh - - � - 4 - - � - 6Exeter - - - - � - � - - 2Gillingham - - � - 2 - - - - 3Glasgow (Strathclyde University) - - � - � - � - - 3Glasgow (Westmarc) - - � - 5 2 - - - 10Hull - - - - 2 - � � - 4Inverness - - � - - - - - - 1Isle of Wight4 - - - - - - - - - -Leeds5 - � 7 - 2 - 8 - - 20Leicester - - - - - - - - - -Liverpool (Fazakerley) - - 4 - - - � - - 5London (Bowley Close)5 - - � - � - - 2 - 6London (Charing Cross)6 - - - - - - - - - -London (Harold Wood) � - 4 - � � - - � 10London (Roehampton) - - � - - - - � 2 4London (Stanmore) � - 2 - 6 - � 4 - 16Luton & Dunstable6 - - - - - - - - - -Manchester - 2 � - � - � 8 - 19Newcastle - � 4 � 2 - - - - 10Northampton - - � - - - � - - 2Norwich - - - - � - - - - 1Nottingham - � � - 2 - - �6 - 22Oxford - - - - 2 - � - - 5Plymouth - - � - � - - � - 3Portsmouth - - � � � - - - - 3Preston - � � - 2 2 4 - 2 12Sheffield - - 4 - � - 2 - � 10Stoke6 - - - - - - - - - -Sussex - - - - - � 2 - - 3Swansea - � 5 - - � � � - 11Wirral - - - - - - 2 - - 2Wolverhampton6 - - - - - - - - - -Wrexham - - - - - - 6 - - 6

All centre 7 13 74 4 54 8 46 65 9 280

Amputee Statistical Database for the United Kingdom : 2004/05 Report �5


Lower Limb Amputations 2 Miscellaneous Amputations � Total

Prosthetics ServiceCentre

Hemi Hip Trans- Knee Ankle Double Cross- Quad- Con-pelvec- disartic- fem- disartic- Trans- disartic- Partial Lower lower site Triple ruple genital

tomy ulation oral ulation tibial ulation foot digits amp. Total amp. amp. amp. absence Total

A few centres have a relatively high proportion of upper limb referrals. Thirteen per cent of referrals to Birmingham, Glasgow (Strathclyde University) and Nottingham were following upper limb amputation. However Glasgow (Strathclyde University) has a very small number of total referrals (24) and the other 2 centres both have a high number of referrals following amputation of digits. Other centres where the referral rate is more than double the national rate of 5 per cent are London’s Stanmore and Bowley Close (200�/04 data) with �� per cent of referrals being upper limb amputees. Neither of these centres have particularly high referrals following amputation of digits.

When comparing the data in Table � with UK hospital activity analysis of upper and lower primary amputations in Table �5 it is clear that only a small proportion of foot and hand amputations are referred to prosthetics centres. A great majority of upper limb digit amputations are never referred and the majority of partial foot amputations are probably seen through district orthotic services.

- - 25 � �� - - - 6 63 - - - � 1 71 Aberdeen- - �� - �7 - - - 9 79 - - - 5 5 92 Belfast2 - �02 5 ��8 � 4 � �0 263 - - - 9 9 311 Birmingham- � �� 68 � � - 6 115 - - - 2 2 123 Bristol- 2 28 - 55 � � - 4 91 - - - � 1 93 Cambridge� � 64 2 7� - 2 - �� 154 - - - 6 6 169 Cardiff- - 7 - �6 - - - � 24 - - - - - 24 Carlisle- � 48 2 47 - - - 9 107 - � - � 4 115 Cleveland- - �9 � 25 - - 2 5 72 - - - � 1 73 Derby6

- � �6 � 46 - - - 5 89 - - � 2 3 97 Dorset- � 28 - 57 - - - � 89 - - - - - 91 Dundee- - 25 - �9 � - - � 66 - - - � 1 73 Edinburgh- - �9 5 66 2 � - �� 126 � - - � 2 130 Exeter- � 4� 4 80 � � - 9 141 � - - 6 7 151 Gillingham- - 7 � �0 - - - � 19 - - - 2 2 24 Glasgow (Strathclyde Uni)

- � 87 � �50 2 2 - 8 253 - - - 5 5 268 Glasgow (Westmarc)

- � 24 � �8 - - - 2 66 - � - 2 3 73 Hull- � � - 26 - - - - 28 - - - - - 29 Inverness- - 6 - 9 - - - - 15 - - - - - 15 Isle of Wight4

� � 5� � 94 - 2 - �7 169 - - - �4 14 203 Leeds5

- - �6 - �9 - - - � 36 - - - 2 2 38 Leicester- 2 56 2 45 2 � - 8 118 - - - 5 5 128 Liverpool (Fazakerley)

- - 24 - �8 - - - 4 46 � - - 2 3 55 London (Bowley Close)5

- - �4 - 60 - - - 4 98 - - - - - 98 London (Charing Cross)6

- 2 54 2 ��7 � 7 2 8 193 2 - � �0 13 216 London (Harold Wood)

� � 26 2 4� - � - 4 78 � - - 2 3 85 London (Roehampton)

2 2 �7 � 69 � 2 - 4 120 - - � �0 11 147 London (Stanmore)

- � �9 � 40 2 2 � 5 91 - - - 2 2 93 Luton & Dunstable6

� 2 �� - �2� � 6 4 2� 271 - - - � 3 293 Manchester- � 49 � 77 2 � - �0 141 - - - 6 6 157 Newcastle- - 2� - �8 - � - � 61 - - - � 1 64 Northampton� � 20 � 69 - - - � 99 - - - � 3 103 Norwich- - 44 5 80 - � � � 134 - - - �0 10 166 Nottingham- - �� 66 - � - � 104 - - � 8 9 118 Oxford� � 42 - 58 - � � � 109 - - - � 3 115 Plymouth- � 28 5 40 - � - � 78 - - - 4 4 85 Portsmouth- � 68 � 54 � � - �4 140 - - - 5 5 157 Preston- 5 72 4 �08 � 2 - �� 203 � - � �� 15 228 Sheffield- - 47 - 5� � - - �0 109 - - - � 1 110 Stoke 6

- � 50 2 48 - 4 - � 108 - - - 2 2 113 Sussex- - 60 - 50 � 2 - 6 119 - - - 2 2 132 Swansea- � 47 - �8 - - - 8 94 - - - 2 2 98 Wirral� - 69 4 55 - - - �0 139 - - - - - 139 Wolverhampton6

- - 20 - 42 - 2 - 4 68 - - - 2 2 76 Wrexham

13 36 1 797 64 2 511 24 58 12 271 4 786 7 2 5 159 173 5 239 All centres


Cha

rt 3a Number of total and lower limb amputations by year April 1997 to March 2005


There is a consistent pattern over time with lower limb amputees accounting for more than 90 per cent of all new referrals.

Lower Amputations 4559 5160 4972 5298 5267 5264 4770 4786

AllAmputations 5862 5661 5451 5765 5724 5713 5204 5239

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rt 3b Number of upper limb and miscellaneous amputations by year April 1997 to March 2005

UpperAmputations 247 255 252 281 260 297 305 280

MiscellaneousAmputations 170 207 182 162 179 134 127 173

No level provided 886 39 45 24 18 18 2 0

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Time interval between amputation and referral

Table 4 below shows the time between amputation being carried out and the referral to a prosthetics service centre. We have altered the time periods this year to focus more on the time period of � to � months. Nationally 66 per cent of referrals are made within the �st month following amputation. However there is considerable variation between the individual centres.

This table contains valuable information but requires careful interpretation. Differences in surgical and physiotherapy practice as well as the operational policies of the centre may account for the variation by centres in referral time during the first 6 months following an amputation. Reasons for referral taking place 6 months or more after amputation may be because of intercurrent disease episodes, late improvement in condition or individuals moving into the NHS as established amputees.


4 Time interval from amputation to receipt of referral by prosthetics service centre : 2004/05Tabl

e

Prosthetics Service Centre < � mths �-2 mths 2-� mths �-6 mths 6-�2 mths >�2 mths Unknown Total number

Percentages�

% % % % % % %Aberdeen 55 20 8 7 � 7 � 71 Belfast 65 �� 5 � 4 �� - 92 Birmingham 72 �� 5 � 2 7 - 311 Bristol 62 �5 2 6 4 �� - 123 Cambridge 88 5 - 2 � � - 93 Cardiff 8� 7 � � � 4 - 169 Carlisle 88 - 4 4 4 - - 24 Cleveland 48 24 �0 5 � �0 - 115 Derby 88 5 � � � � - 73 Dorset 85 7 � - 2 � - 97 Dundee 97 � - - - 2 - 91 Edinburgh 4� 26 �0 �� 7 5 - 73 Exeter 90 � � � � 7 - 130 Gillingham 75 �0 2 4 2 7 - 151 Glasgow (Strathclyde Uni) 7� 8 4 - 4 4 8 24 Glasgow (Westmarc) 62 �6 9 6 � 4 2 268 Hull 7� �� - 73 Inverness �� 48 �0 7 - � - 29 Isle of Wight� 67 �� 7 - - - �� 15 Leeds2 0 20 �� 25 �0 �� - 203 Leicester 84 5 5 � � - - 38 Liverpool (Fazakerley) 77 5 6 � � 9 - 128 London (Bowley Close)2 56 �� 5 �� 2 �5 - 55 London (Charing Cross) 78 5 4 � � 9 - 98 London (Harold Wood) 47 �6 8 7 � 2� - 216 London (Roehampton) 54 �9 5 5 4 �4 - 85 London (Stanmore) 65 �2 � 7 � 9 - 147 Luton & Dunstable 7� 6 9 8 2 2 - 93 Manchester 76 5 5 5 2 7 - 293 Newcastle 68 �� 6 6 2 7 - 157 Northampton 55 �7 8 �� 6 2 - 64 Norwich 59 �� 7 9 9 6 - 103 Nottingham �5 2� �6 �� 6 7 � 166 Oxford 48 8 4 6 5 29 - 118 Plymouth 92 � � 2 2 - � 115 Portsmouth 56 25 7 5 4 2 � 85 Preston 46 �9 �0 6 6 �� - 157 Sheffield 8� 5 0 � 2 8 - 228 Stoke 8� 6 � - 2 7 � 110 Sussex 72 9 6 6 - 7 - 113 Swansea 89 2 � 2 � � - 132 Wirral 76 �6 - 2 � � - 98 Wolverhampton 70 �9 4 - � 6 - 139 Wrexham 55 2� 9 9 - 4 � 76

All centres: % 66 �2 6 5 � 8 0All centres: number 3 455 616 320 277 150 406 15 5 239

Time Interval

0 indicates less than �%� 2000/0� data. 2 200�/04 data. � Due to rounding row percentages may not add up to �00%.


Chart 4a presents the time interval in weeks between date of amputation and receipt of referral focussing in on the first �2 weeks and highlights a gradual trend towards earlier referral.

4a Time interval (weeks) between date of amputation and receipt of referral by year April 1997 to March 2005

Cha

rt

2 wks 1464 1780 2310 2376 2025 2195 2177 2449

2-4 wks 1074 1180 1024 1064 1137 1078 930 927

4-6 wks 542 554 541 562 612 537 492 421

6-12 wks 693 700 589 655 746 637 645 541

>12 wks 1294 1185 908 1075 1151 1079 921 886

Unknown 270 262 79 33 53 57 39 15

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Over time there is a fairly consistent pattern between amputation and referral for those referred � months or more after amputation. The number of referrals made �2 months or more after amputation had been decreasing however this year there is an increase.

3-6 mths 355 367 261 370 368 321 343 277

6-9 mths 113 105 93 149 127 104 121 96

9-12 mths 78 64 50 70 56 70 49 54

>12 mths 683 599 454 436 548 530 347 406

Unknown 270 262 79 33 53 57 39 15

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Cha

rt 4b Time interval (>3 months) between date of amputation and receipt of referral : 2004/05

4c Time interval (> 3 months) between date of amputation and receipt of referral by year April 1997 to March 2005

Cha

rt

Chart 4b presents information on patients referred three months or more after their amputation. Sixteen per cent of referrals to prosthetics centres were carried out � months or more after the date of amputation. Four hundred and six patients (8%) were referred more than �2 months after their amputation was carried out.

0

2

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6

8

10

Unknown> 12 mths9-12 mths6-9 mths3-6 mths

Per

cent

age


Amputee Statistical Database for the United Kingdom : 2004/05 Report 2�


UPPeR lIMB AMPUTATIONS


Upper limb AmputationsTa

ble

� Excludes congenital absence cases.2 Derby, London Charing Cross, Luton and Dunstable, Stoke and Wolverhampton do not provide an upper limb service.� Due to rounding row percentages may not add up to �00%.4 2000/0� data.5 200�/04 data.

Level of amputation�

Prosthetics ServiceCentre 2

Total no.of referrals

level of amputation by centre

In this table the number of upper limb referrals to each centre is expressed as a percentage according to level of amputation. Almost half the upper limb referrals in 2004/05 were to just 7 centres and only two of these had more than twenty referrals. As in previous years Birmingham received the most new referrals (�9). Nottingham had the next highest number (22). It is important to note that for many centres the total number of upper limb amputee referrals is very small and comparisons between centres requires careful examination of the data. Seventy two per cent of the centres received less than �0 new upper limb referrals in 2004/05.

Almost half of all upper limb referrals are following trans-humeral or trans-radial amputations. Partial hand and upper digit amputees account for �9 per cent of referrals.

Please see Table �5 for information on Hospitals Activity Analysis for UK upper and lower primary amputations 2004/05.

5 level of amputation as a percentage of total number; by prosthetics service centre : 2004/05

Row percentages3

% % % % % % % % %Aberdeen - 14 14 - 14 - 29 29 - 7 Belfast - 13 25 - 38 13 13 - - 8 Birmingham - 5 28 - 3 - - 56 8 39 Bristol - - 50 - 33 - - 17 - 6 Cambridge - - - - 100 - - - - 1 Cardiff - - 33 - 11 - 56 - - 9 Carlisle - - - - - - - - - - Cleveland 25 - - - - - - 75 - 4 Dorset 40 - 20 - 20 - 20 - - 5 Dundee - - 100 - - - - - - 2 Edinburgh - - 17 - 67 - - 17 - 6 Exeter - - - - 50 - 50 - - 2 Gillingham - - 33 - 67 - - - - 3 Glasgow (Strathclyde University) - - 33 - 33 - 33 - - 3 Glasgow (Westmarc) - - 30 - 50 20 - - - 10 Hull - - - - 50 - 25 25 - 4 Inverness - - 100 - - - - - - 1 Isle of Wight4 - - - - - - - - - - Leeds5 - 15 35 - 10 - 40 - - 20 Leicester - - - - - - - - - - Liverpool (Fazakerley) - - 80 - - - 20 - - 5 London (Bowley Close)5 - - 50 - 17 - - 33 - 6 London (Harold Wood) 10 - 40 - 30 10 - - 10 10 London (Roehampton) - - 25 - - - - 25 50 4 London (Stanmore) 19 - 13 - 38 - 6 25 - 16 Manchester - 11 16 - 16 - 16 42 - 19 Newcastle - 10 40 30 20 - - - - 10 Northampton - - 50 - - - 50 - - 2 Norwich - - - - 100 - - - - 1 Nottingham - 5 14 - 9 - - 73 - 22 Oxford - - - - 40 - 60 - - 5 Plymouth - - 33 - 33 - - 33 - 3 Portsmouth - - 33 33 33 - - - - 3 Preston - 8 8 - 17 17 33 - 17 12 Sheffield - - 40 - 30 - 20 - 10 10 Sussex - - - - - 33 67 - - 3 Swansea - 9 45 - - 9 9 27 - 11 Wirral - - - - - - 100 - - 2 Wrexham - - - - - - 100 - - 6

All centres: % 3 5 26 1 19 3 16 23 3

All centres: number 7 13 74 4 54 8 46 65 9 280

Shoulder Elbow Wrist Double Fore- disartic- Trans- disartic- Trans- disartic- Partial Upper upper quarter ulation humeral ulation radial ulation hand digits amp.


Upper limb Amputations

6 level of amputation : 2004/05Cha

rt

level of amputation by gender and age

As with lower limb referrals the majority of upper limb referrals are male (66%). However, unlike lower limb referrals, upper limb referrals tend to be in the younger age groups reflecting the aetiology of the condition (mainly trauma). Two in every five upper limb referrals were male aged between �6 – 54 years. Female referrals aged �6 –54 years accounted for �8 per cent of all upper limb referrals, which is similar to last year’s figure (�9%). .

Wrist disarticulation 3% Forequarter 3%

Double upper amputation 3%

Elbowdisarticulation 1%

UpperDigits 23%

Shoulderdisarticulation 5%

Trans-humeral 26%

Trans-radial 19%

Partialhand 16%

less 75 less 75 Not than and All than and All speci- 16 16-54 55-64 65-74 over ages 16 16-54 55-64 65-74 over ages fied

Forequarter - 2 - 2 1 5 - - 1 1 - 2 - 7Shoulder disarticulation - 6 2 - 2 10 - 1 - 2 - 3 - 13Trans-humeral 4 29 5 5 3 46 - 11 8 3 6 28 - 74Elbow disarticulation - 1 1 - 1 3 - 1 - - - 1 - 4Trans-radial 1 20 5 4 6 36 2 10 3 1 2 18 - 54Wrist disarticulation - 6 - - - 6 - 1 1 - - 2 - 8Partial hand - 23 5 2 - 30 2 10 1 1 1 15 1 46Upper Digits 3 26 9 3 1 42 4 16 1 2 - 23 - 65Double upper amputation 1 4 1 - - 6 1 1 1 - - 3 - 9 All upper limb amputations1 9 117 28 16 14 184 9 51 16 10 9 95 1 280

� Excludes congenital absence cases.

6 Level of amputation1; by gender and age : 2004/05

Level of amputation1

Tabl

e

Males Females Total



Cause and level

A cause of upper limb loss was recorded in 94 per cent (262) of the total referrals following upper limb amputation. Trauma accounted for 65 per cent, an increase of �� per cent on the previous year’s figure, where mechanical trauma was most common. Neoplasia accounted for �� per cent of referrals and dysvascularity for 8 per cent. These figures are similar to those recorded in 200�/04.

Cause of amputation

Shoulder Elbow Wrist Double Fore- disartic- Trans- disartic- Trans- disartic- Partial Upper upper quarter ulation humeral ulation radial ulation hand digits amp.

7 Level of amputation; by cause of amputation : 2004/05 Tabl

e

Level of amputation1 Total

Trauma 1 4 35 3 30 8 37 47 5 170No Additional Detail - 1 10 1 13 3 7 15 1 51Mechanical 1 2 21 1 12 3 25 30 1 96Electrical - - 4 - 4 1 1 - 1 11Thermal - - - 1 1 1 3 2 1 9Chemical - 1 - - - - 1 - 1 3

Dysvascularity - - 8 - 7 - 4 - 1 20No Additional Detail - - 1 - 1 - 1 - - 3Diabetes Mellitus - - 1 - 1 - 1 - - 3Non-diabetic Arteriosclerosis - - 3 - 1 - 1 - - 5Embolism - - 2 - 2 - 1 - - 5Vasospatic Conditions(inc. Raynauds) - - - - - - - - - -Disseminated IntravascularCoagulation - - - - - - - - 1 1Endovascular ChemicalTrauma (Substance Abuse) - - - - 1 - - - - 1Buergers Disease - - - - 1 - - - - 1Iatrogenic Vascular Trauma - - - - - - - - - -Arteritis (inc. RheumatoidArthritis, Autoimmune Disease) - - - - - - - - - -Venous Disease - - 1 - - - - - - 1

Infection 1 - 8 - 2 - 2 1 1 15No Additional Detail - - 1 - 1 - - - - 2Acute - - 3 - 1 - 2 1 - 7Chronic 1 - 4 - - - - - 1 6

Neurological Disorder - 1 2 - - - - 1 1 5No Additional Detail - - - - - - - - - -Diabetic Neuropathy - - - - - - - - 1 1Infective (inc. Leprosy, Madura Foot) - - - - - - - - - -SpinaBifida - - - - - - - - - -Poliomyelitis - 1 - - - - - - - 1Peripheral Nerve Injury - - 2 - - - - 1 - 3

Neoplasia 5 8 12 1 8 - 1 - - 35No Additional Detail - - 2 - 1 - 1 - - 4Benign 1 1 1 - 1 - - - - 4Malignant - Primary 3 6 9 - 6 - - - - 24Malignant - Secondary 1 1 - 1 - - - - - 3

Other - No Additional Detail - - 4 - 7 - 2 4 - 17

No Cause Provided - - 5 - - - - 12 1 18

All causes1 7 13 74 4 54 8 46 65 9 280

� Excludes congenital absence cases.


7 Number of upper limb amputations by cause and year April 1997 to March 2005Cha

rt

The number of new referrals for upper limb amputees has decreased for the first time since 200�/02. The number of amputations not relating to trauma or dysvascularity (“all other”) have dropped back to previous levels at 27 per cent. The number of records with “no cause provided” has risen slightly after falling substantially last year. However it is still lower at 6 per cent than the years preceding 200�/04.


Trauma 93 115 120 140 142 166 163 170

Dysvascularity 7 7 28 23 16 30 24 20

No Cause provided 83 69 43 33 21 37 1 18

All Other 64 64 61 85 81 64 117 72

All causes 247 255 252 281 260 297 305 280

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8 Cause of amputation; by age : 2004/05Tabl

e

8 Cause of amputation : 2004/05 including 'No cause provided'

Cha

rtUpper limb Amputations

Cause and age

As in previous years, trauma was the most common cause of upper limb loss although this is not consistent across all age groups. Trauma was the most common cause within the �6–54 age group, however for those aged over 65 there were a similar number of referrals following amputation because of neoplasia.

Neurological Disorder 2%Infection 5%

Dysvascularity 7%

Neoplasia 13%

Other 6%

No Cause Provided 6%

Trauma 61%

Cause of amputation1

less than 75 16 16-54 55-64 65-74 and over

Age Group Total

� Excludes congential absence.

Trauma 9 120 24 10 7 170No Additional Detail 4 37 5 3 2 51Mechanical 2 68 16 6 4 96Electrical 2 7 1 1 - 11Thermal 1 6 1 - 1 9Chemical - 2 1 - - 3

Dysvascularity 4 9 2 2 3 20No Additional Detail - 3 - - - 3Diabetes Mellitus - 1 - 1 1 3Non-diabetic Arteriosclerosis 1 1 - 1 2 5Embolism 1 2 2 - - 5Disseminated IntravascularCoagulation 1 - - - - 1Endovascular ChemicalTrauma (Substance Abuse) - 1 - - - 1Buergers Disease - 1 - - - 1Venous Disease 1 - - - - 1

Infection - 6 6 2 1 15No Additional Detail - 1 1 - - 2Acute - 4 1 2 - 7Chronic - 1 4 - 1 6

Neurological Disorder 1 3 - - 1 5Diabetic Neuropathy - 1 - - - 1Poliomyelitis - - - - 1 1Peripheral Nerve Injury 1 2 - - - 3

Neoplasia 1 11 6 9 8 35No Additional Detail - 1 1 1 1 4Benign - 2 1 - 1 4Malignant - Primary 1 8 3 6 6 24Malignant - Secondary - - 1 2 - 3

Other 2 9 2 2 2 17

No Cause Provided 1 11 4 1 1 18

Total 18 169 44 26 23 280



lOweR lIMB AMPUTATIONS


9 level of amputation as a percentage of total number; by prosthetics service centre : 2004/05

Total no.of referrals

lower limb AmputationsTa

ble

Hemi Hip Knee Ankle Double pelvec- disartic- Trans- disartic- Trans- disartic- Partial Lower lower tomy ulation femoral ulation tibial ulation foot Digits amp. Prosthetics ServiceCentre

Level of amputation�

level of amputation by centre

The number of referrals to each centre is expressed as a percentage according to the level of lower limb amputation. Nine out of ten referrals following lower limb amputations were either trans-tibial (52%) or trans-femoral (�8%), this is similar to the previous years. There is substantial local variation in the percentage of patients referred following trans-tibial and trans-femoral amputations which may reflect referral patterns rather than surgical practice. For example:

Norwich (99 new referrals) : trans-tibial 70%, trans-femoral 20%Derby (72 new referrals) : trans-tibial �5%, trans-femoral 54%Cleveland (�07 new referrals) : trans-tibial 44% trans-femoral 45%

0 indicates less than �%� Excludes congenital absence cases.2 Due to rounding row percentages may not add up to �00%.� 2000/0� data.4 200�/04 data.

Row percentages2

% % % % % % % % %

Aberdeen - - 40 2 49 - - - 10 63Belfast - - 42 - 47 - - - 11 79Birmingham 1 - 39 2 52 0 2 0 4 263Bristol - 1 29 3 59 1 3 - 5 115Cambridge - 2 31 - 60 1 1 - 4 91Cardiff 1 1 42 1 47 - 1 - 7 154Carlisle - - 29 - 67 - - - 4 24Cleveland - 1 45 2 44 - - - 8 107Derby - - 54 1 35 - - 3 7 72Dorset - 1 40 1 52 - - - 6 89Dundee - 1 31 - 64 - - - 3 89Edinburgh - - 38 - 59 2 - - 2 66Exeter - - 31 4 52 2 2 - 9 126Gillingham - 1 30 3 57 1 2 - 6 141Glasgow (Strathclyde University) - - 37 5 53 - - - 5 19Glasgow (Westmarc) - - 34 1 59 1 1 - 3 253Hull - 2 36 2 58 - - - 3 66Inverness - 4 4 - 93 - - - - 28Isle of Wight3 - - 40 - 60 - - - - 15Leeds4 1 1 31 1 56 - 1 - 10 169Leicester - - 44 - 53 - - - 3 36Liverpool (Fazakerley) - 2 47 2 38 2 3 - 7 118London (Bowley Close)4 - - 52 - 39 - - - 9 46London (Charing Cross) - - 35 - 61 - - - 4 98London (Harold Wood) - 1 28 1 61 1 4 1 4 193London (Roehampton) 1 1 33 3 55 - 1 - 5 78London (Stanmore) 2 2 31 1 58 3 2 - 3 120Luton & Dunstable - 1 43 1 44 2 2 1 5 91Manchester 0 1 42 - 45 - 2 1 8 271Newcastle - 1 35 1 55 1 1 - 7 141Northampton - - 34 - 62 - 2 - 2 61Norwich 3 1 20 3 70 - - - 3 99Nottingham - - 33 4 60 - 1 1 2 134Oxford - - 32 1 63 - 1 - 3 104Plymouth 1 3 39 - 53 - 1 1 3 109Portsmouth - 1 36 6 51 - 1 - 4 78Preston - 1 49 1 39 1 1 - 10 140Sheffield - 2 35 2 53 0 1 - 5 203Stoke - - 43 - 47 1 - - 9 109Sussex - 1 46 2 44 - 4 - 3 108Swansea - - 50 - 42 1 2 - 5 119Wirral - 1 50 - 40 - - - 9 94Wolverhampton 1 - 50 3 40 - - - 7 139Wrexham - - 29 - 62 - 3 - 6 68

All centres: % 0 1 38 1 52 1 1 0 6

All centres: total no. 13 36 1797 64 2511 24 58 12 271 4786


9a Number of lower limb amputations by level and year April 1997 to March 2005Cha

rt

9b Number of lower limb amputations by level and year (excluding trans-femoral and trans-tibial) April 1997 to March 2005

Cha

rt

The level of referrals following lower limb amputations has remained fairly constant, as has the difference between referrals following trans-tibial and trans-femoral amputations.

The number of referrals following double lower amputation remains similar to last year. Over the eight years there has been a reduction in referrals following lower digit amputation. This may reflect a change in the referral practice for such amputees.

lower limb Amputations

Trans-femoral 1746 1973 1788 2072 2099 1971 1811 1797

Trans-tibial 2309 2721 2713 2751 2624 2733 2482 2511

All other 504 466 471 475 544 560 477 478

All lower Amputations 4559 5160 4972 5298 5267 5264 4770 4786

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Hemi-pelvectomy 11 12 11 14 21 19 9 13

Hip disarticulation 28 25 18 28 33 38 29 36

Knee disarticulation 126 100 93 103 97 97 67 64

Ankle disarticulation 26 32 33 29 24 24 19 24

Partial foot 30 35 73 96 76 67 78 58

Lower digits 107 42 41 25 16 19 13 12

Double lower amputation 176 220 202 180 277 296 262 271

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level of amputation by gender and age

More than two thirds of lower limb amputees referred in 2004/05 were male (70%). Just over half of all male referrals were at a the trans-tibial level (55%) with a slightly lower proportion in females (48%): the great majority of the remaining amputations were at the trans-femoral level (�6% in males and 42% in females).

There is a higher percentage of females aged 75 and over (5�%) referred following a trans-femoral amputation than males aged 75 and over (4�%).

10 level of amputation : 2004/05Cha

rt

All other lower limb amputations 4%Double lower amputation 6%

Trans-femoral 38%

Trans-tibial 52%

10 Level of amputation; by gender and age : 2004/05

less 75 less 75 than and All than and All 16 16-54 55-64 65-74 over ages 16 16-54 55-64 65-74 over ages Level of amputation1

Tabl

e

Males FemalesTotal

NotSpeci-fied

Hemi-pelvectomy - 7 3 1 - 11 - 1 - 1 - 2 - 13Hip disarticulation - 11 8 5 1 25 1 3 - 6 1 11 - 36Trans-femoral 10 210 244 358 364 1 186 3 69 91 126 321 610 1 1 797Knee disarticulation - 17 7 4 12 40 1 3 1 10 9 24 - 64Trans-tibial 9 422 411 516 460 1 818 2 131 124 163 273 693 - 2 511Ankle disarticulation 4 10 2 1 3 20 2 1 1 - - 4 - 24Partial foot - 16 6 4 7 33 3 10 6 1 5 25 - 58Lower digits - 1 1 1 1 4 1 2 1 1 3 8 - 12Double lower amputation 7 34 49 62 40 192 3 26 13 16 21 79 - 271

All lower limb amputations1 30 728 731 952 888 3 329 16 246 237 324 633 1 456 1 4 786

� Excludes cases of congenital absence.



Cause and level

A cause of lower limb loss was recorded in 98 per cent of all referrals following lower limb amputation with dysvascularity accounting for 77 per cent of these amputations. Within each cause of amputation (apart from neoplasia) the most common level of amputation is trans-tibial. Patients whose amputation was as a result of neoplasia are more likely to have had a trans-femoral amputation.

The aim is to collect the cause of amputation at a more detailed level. However one quarter of records were submitted with “no additional detail” codes or no cause provided. In particular �0 per cent of trauma cases did not specify the type of trauma.

Cause of amputation

Hemi Hip Knee Ankle Double pelvec- disartic- Trans- disartic- Trans- disartic- Partial Lower lower tomy ulation femoral ulation tibial ulation foot Digits amp.

Level of amputation1

Total

� Excludes congenital absence.

Trauma 2 6 126 15 236 4 17 1 19 426No Additional Detail 1 3 35 6 69 2 7 1 5 129Mechanical 1 3 81 8 149 1 7 - 10 260Electrical - - 4 1 7 - 2 - - 14Thermal - - 2 - 9 1 - - 3 15Chemical - - 4 - 2 - 1 - 1 8

Dysvascularity 3 9 1,385 38 1,891 7 25 6 216 3 580No Additional Detail 1 5 393 13 399 - 2 - 40 853Diabetes Mellitus 1 - 364 9 995 5 13 2 101 1 490Non-diabetic Arteriosclerosis - 3 530 15 409 1 7 4 60 1 029Embolism - 1 35 - 29 - 1 - - 66Vasospatic Conditions (inc. Raynauds) - - 3 - 4 - - - 1 8Disseminated Intravascular Coagulation - - 2 - 3 - - - 2 7Endovascular Chemical Trauma (Substance Abuse) 1 - 8 - 3 - - - 1 13Buergers Disease - - 5 - 5 1 - - 3 14 Iatrogenic Vascular Trauma - - 4 - 2 - - - 1 7Arteritis (inc. RheumatoidArthritis, Autoimmune Disease) - - 18 1 21 - 2 - 4 46Venous Disease - - 23 - 21 - - - 3 47

Infection - 9 123 4 174 5 6 - 15 336No Additional Detail - 4 35 - 45 1 - - 4 89Acute - 3 28 1 27 3 1 - 8 71Chronic - 2 60 3 102 1 5 - 3 176

Neurological Disorder - 1 12 1 52 5 - - 4 75No Additional Detail - - 1 - 10 1 - - 1 13Diabetic Neuropathy - - 5 - 29 1 - - 2 37Infective - 1 1 - 1 - - - - 3SpinaBifida - - 1 - 6 2 - - 1 10Poliomyelitis - - 1 1 2 - - - - 4Peripheral Nerve Injury - - 3 - 4 1 - - - 8

Neoplasia 6 8 61 1 36 - 4 3 - 119No Additional Detail - 2 4 - 3 - - - - 9Benign - - 3 - 2 - - - - 5Malignant - Primary 6 6 49 1 27 - 4 3 - 96Malignant - Secondary - - 5 - 4 - - - - 9

Other - 3 46 3 70 3 4 1 11 141

No Cause Provided 2 - 44 2 52 - 2 1 6 109

All causes1 13 36 1 797 64 2 511 24 58 12 271 4 786

11 Level of amputation; by cause of amputation : 2004/05 Tabl

e


lower limb Amp utations

11 Number of lower limb amputations by cause and year April 1997 to March 2005Cha

rt

The incidence of referrals following lower limb amputation arising from dysvascularity has increased slightly this year from 70 per cent in 200�/04 to 75 per cent. The number of cases with “no cause provided” has increased slightly to 2 per cent, however this is significantly less than the numbers recorded prior to 200�/04.

Trauma 323 400 443 448 432 443 390 426

Dysvascularity 2231 2865 3051 3464 3506 3724 3354 3580

No Cause provided 1192 1090 494 532 274 294 38 109

All Other 813 805 984 854 1055 803 988 671

All causes 4559 5160 4972 5298 5267 5264 4770 4786

0

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2000

3000

4000

5000

6000

2004/052003/042002/032001/022000/011999/001998/991997/98

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1000

2000

3000

4000

5000

6000


12 Cause of amputation : 2004/05 including 'No cause provided'

Cha

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Cause and age

Dysvascularity is the most common cause of lower limb amputation in all age groups apart from those aged under �6. The most common age group for dysvascularity referrals is 75 years and over. For all other aetiologies the most commonly referred age group is �6 – 54 years.

There is a strong association between age and cause of amputation. Twelve per cent of referrals following amputation due to dysvascularity were aged under 55 years compared with �6 per cent aged over 75 years. Trauma, on the other hand, mainly occurred in the younger age groups with 72 per cent of lower limb referrals aged less than 55 and only 9 per cent aged over 75. It is surprising that causes of dysvascularity are reported in the under �6 age group however coding errors may account for some of these cases.


Neoplasia 2%NeurologicalDisorder 2%

Infection 7%

Trauma 9%

Other 3%

No Cause Provided 2%

Dysvascularity 75%

12 Cause of amputation; by age : 2004/05

Cause of amputation1

less 75 than 16-54 55-64 65-74 and 16 over

Age Group Total

� Excludes congenital absence cases

Trauma 11 294 52 31 38 426No Additional Detail 2 85 15 14 13 129Mechanical 9 188 28 14 21 260Electrical - 10 1 2 1 14Thermal - 5 6 1 3 15Chemical - 6 2 - - 8Dysvascularity 7 434 775 1,092 1,272 3 580No Additional Detail 2 86 161 257 347 853Diabetes Mellitus 2 200 392 500 396 1 490Non-diabetic Arteriosclerosis 2 84 186 281 476 1 029Embolism - 20 12 18 16 66Vasospatic Conditions - 2 - 1 5 8Disseminated Intravascular Coagulation - 2 2 2 1 7Endovascular Chemical Trauma - 11 - 2 - 13Buergers Disease - 7 2 2 3 14Iatrogenic Vascular Trauma 1 3 1 2 - 7Arteritis - 11 11 16 8 46Venous Disease - 8 8 11 20 47Infection 7 109 60 67 93 336No Additional Detail 2 27 11 23 26 89Acute 4 27 14 8 18 71Chronic 1 55 35 36 49 176Neurological Disorder 4 31 18 14 8 75No Additional Detail - 8 2 3 - 13Diabetic Neuropathy - 12 12 8 5 37Infective - 2 - - 1 3SpinaBifida 2 8 - - - 10Poliomyelitis - 1 1 2 - 4Peripheral Nerve Injury 2 - 3 1 2 8Neoplasia 9 40 21 27 22 119No Additional Detail 1 4 3 1 - 9Benign 2 1 1 1 - 5Malignant - Primary 6 34 16 21 19 96Malignant - Secondary - 1 1 4 3 9Other 7 48 20 26 40 141No Cause Provided 1 18 22 19 49 109All causes1 46 974 968 1 276 1 522 4 786

Tabl

e



MISCellANeOUS


Miscellaneous

13 Multiple amputation1 by cause of amputation, gender and age : 2004/05 Tabl

e

Multiple amputations

The number of multiple amputations are small but this subgroup is important to identify since the care costs for each case are substantial.

13 Number of multiple amputations by year April 1997 to March 2005 Cha

rt

0

5

10

15

20

2004/052003/042002/032001/022000/011999/001998/991997/98

Num

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0

5

10

15

20

Males Females

Total TotalCause of amputation2

Total

� Bilateral upper limb and bilateral lower limb amputations appear in previous tables.2 Excludes congenital absence cases.

<16 16-54 55-64 65-74 75+ <16 16-54 55-64 65-74 75+

Cross site amputation - 3 2 1 1 7 - - - - - - 7Trauma - No Additional Detail - - - - 1 1 - - - - - - 1Trauma - Mechanical - 2 - - - 2 - - - - - - 2Trauma - Chemical - 1 - - - 1 - - - - - - 1Dysvascularity - No Additional Detail - - - 1 - 1 - - - - - - 1Dysvascularity - Diabetes Mellitus - - 1 - - 1 - - - - - - 1Dysvascularity - Non-diabetic Arteriosclerosis - - 1 - - 1 - - - - - - 1

Triple amputation - 1 - - - 1 - 1 - - - 1 2Dysvascularity - Diabetes Mellitus - 1 - - - 1 - - - - - 1Dysvascularity - DisseminatedIntravascular Coagulation - - - - - - - 1 - - - 1 1

Quadruple amputation - 1 1 - - 2 - 2 - 1 - 3 5Dysvascularity - No Additional Detail - - - - - - - 1 - - - 1 1Dysvascularity - Embolism - - - - - - - 1 - - - 1 1Infection - Acute - 1 1 - - 2 - - - 1 - 1 3

Total - 5 3 1 1 10 - 3 - 1 - 4 14

Multiple amputations 6 14 18 17 7 15 11 14


Miscellaneous

14 Congenital absence; by prosthetics service centre, gender and age : 2004/05Tabl

e

Congenital absence

There were a similar number of males and females referred with a congenital absence. There are slightly more referrals for upper limb congenital absence (60%) than lower limb (40%). Nineteen per cent of congenital abnormalities involve a surgical amputation.

Sixty-four per cent of all referrals for congenital absence are under �6 years of age. Seventy-seven per cent of upper limb congenital absence referrals were aged under �6 years, compared with 45 per cent of lower limb congenital absence referrals.

less 75 less 75 than and All than and All 16 16-54 55-64 65-74 over ages 16 16-54 55-64 65-74 over ages

Males Females

Upper Congenital - Surgical Amputation Cardiff 1 - - - - 1 1 - - - - 1 2 Portsmouth 1 - - - - 1 1 - - - - 1 2 Sheffield - 1 - - - 1 - - - 1 - 1 2 Total 2 1 - - - 3 2 - - 1 - 3 6

Upper Congenital - No Amputation Belfast 2 - - 1 - 3 2 - - - - 2 5 Birmingham 4 - - - - 4 3 - 1 - - 4 8 Bristol - - - - - - 1 - - - - 1 1 Cardiff 1 - - - - 1 1 - - - - 1 2 Cleveland - 1 - - - 1 - - - - - - 1 Gillingham 3 - - - - 3 1 - - - - 1 4 Glasgow (Strathclyde) - - - - - - 2 - - - - 2 2 Glasgow (Westmarc) 1 - - - - 1 3 - - - - 3 4 Hull - - - - - - 2 - - - - 2 2 Leeds 3 4 - - - 7 3 1 - - - 4 11 Leicester 1 - - - - 1 1 - - - - 1 2 Liverpool (Fazakerley) 1 - - - - 1 - - - - - - 1 London (Bowley Close) - - - - - - - 1 - - - 1 1 London (Harold Wood) - 2 - - - 2 1 1 - - - 2 4 London (Roehampton) - - - - - - 1 - - - - 1 1 London (Stanmore) 1 - - - - 1 2 - - - - 2 2 Manchester 1 - - - - 1 - - - - - - 1 Newcastle 1 - - - - 1 2 1 1 - - 4 6 Northampton - - - - - - 1 - - - - 1 1 Norwich 1 - - - - 1 1 - - - - 1 2 Nottingham 4 - - - - 4 1 - - - - 1 5 Oxford 3 - - - - 3 1 - - - - 1 4 Plymouth 1 - - - - 1 1 - - 1 - 2 3 Portsmouth 2 - - - - 2 - - - - - - 2 Preston 1 1 - - - 2 1 1 - - - 2 4 Sheffield 2 - - - - 2 1 - - - - 1 3 Sussex - 1 - - - 1 1 - - - - 1 2 Swansea 1 - - - - 1 1 - - - - 1 2 Wirral - 1 - - - 1 - - - - - - 1 Wrexham 1 - - 1 - 2 - - - - - - 2 Total 35 10 - 2 - 47 34 5 2 1 - 42 89

Total UpperCongenital Absence 37 11 - 2 - 50 36 5 2 2 - 45 95

Lower Congenital - Surgical Amputation Birmingham 1 - - - - 1 - - - - - - 1 Cambridge - 1 - - - 1 - - - - - - 1 Cardiff 1 1 - - - 2 - - - - - - 2 Derby - 1 - - - 1 - - - - - - 1 Edinburgh - - - - - - - - - 1 - 1 1 London (Roehampton) - - - - - - - 1 - - - 1 1 London (Stanmore) 1 2 - - - 3 1 - - - - 1 4 Luton & Dunstable - 1 - - - 1 - 1 - - - 1 2 Newcastle - - - - - - - 1 - - - 1 1 Norwich 1 - - - - 1 - - - - - - 1 Nottingham - 1 - - - 1 1 - - - - 1 2 Oxford - - - - - - - 1 - - - 1 1 Preston - - - - - - - 1 - - - 1 1 Sheffield 1 2 - - - 3 - 3 - - - 3 6 Total 5 9 - - - 14 2 8 - 1 - 11 25

Lower Congenital - No Amputation Aberdeen - 1 - - - 1 - - - - - - 1 Bristol - - - - 1 1 - - - - - - 1 Cleveland - - - 1 - 1 - 1 - - - 1 2 Dorset 2 - - - - 2 - - - - - - 2 Exeter - - - - - - - 1 - - - 1 1 Gillingham - - - - - - - 2 - - - 2 2 Glasgow (Westmarc) - 1 - - - 1 - - - - - - 1 Leeds - - - - - - 2 1 - - - 3 3 Liverpool (Fazakerley) 1 1 - - - 2 1 - 1 - - 2 4 London (Bowley Close) - - - - - - 1 - - - - 1 1 London (Harold Wood) 1 2 - - - 3 3 - - - - 3 6 London (Stanmore) 1 - - - - 1 2 - - - - 2 3 Manchester 2 - - - - 2 - - - - - - 2 Nottingham - - - - - - - 3 - - - 3 3 Oxford 1 - - - - 1 2 - - - - 2 3 Sheffield 1 - - - - 1 1 - - - - 1 2 Stoke - - - - - - - 1 - - - 1 1 Wirral - - - - - - 1 - - - - 1 1 Total 9 5 - 1 1 16 13 9 1 - - 23 39

Total LowerCongenital Absence 14 14 - 1 1 30 15 17 1 1 - 34 64

All Congenital Absence 51 25 - 3 1 80 51 22 3 3 - 79 159

Prosthetics Service Centre

Total


14 Number of congenital absences by gender and year April 1997 to March 2005

There is an increase in the number of congenital absences in 2004/05. This reverses the previous downward trend since 200�/02.

Femalecongenital 73 96 72 71 86 47 48 79

Malecongenital 91 97 91 74 86 72 59 80

Total congenital absence 164 193 164 145 172 119 107 159

0

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ADDITIONAl INfORMATION


Additional Information

The aim of this section is to consider information sources other than the NASDAB minimum dataset to paint a broader picture of the amputee population at large and to undertake one off analysis in specific areas of interest. The content of this section changes year on year. This year this section includes:

Primary amputations in the UK 2004/05

Age profile of younger people referred to prosthetics service centres

Referrals following amputation because of dysvascularity

The information published last year on prevalence of amputees within the general population and gender difference in lower limb amputee referrals is available on the nasdab website – www.nasdab.co.uk

Primary amputations in the UK 2004/05

The table below presents data on the number of upper and lower limb amputations carried out in hospitals within the United Kingdom during 2004/05. The total number of primary amputations in the United Kingdom has increased this year from �6,699 in 200�/04 to �7,0�9. The most common level of amputation within the UK is amputation of the leg at �7 per cent. This rate varies within the four countries with leg amputations in Scotland accounting for 45 per cent and 28 per cent in Northern Ireland.

•

•

•

X07 includes forequarter amputation, disarticulation of shoulder, amputation of arm above elbow, amputation of arm through elbow, amputation of arm

through forearm and other amputation of arm. X08 includes amputation of hand at wrist, amputation of thumb, amputation of phalanx of finger, amputation of finger (nec) and other amputation of

hand.X09 includes hindquarter amputation, disarticulation of hip, amputation of left above knee, amputation of leg through knee, amputation of leg below

knee and other amputation of knee. X�0 includes amputation of foot through ankle, disarticulation of tarsal bones, disarticulation of metatarsal bones, amputation through metatarsal bones

and other amputation of foot. X�� includes amputation of great toe, amputation of phalanx of toe and other amputation of toe.

Source: England - DOH - Hospital Episodes, Northern Ireland - Hospital Inpatient Systems, Scotland - ISD Scotland SMR0�, Wales - WAREHOUSEDB - Discharges.

OPCS Operation England Scotland Wales� Northern TotalCode Ireland

� Data only 9�% complete.

Total 13 854 1 779 967 439 17 039

X07 Amputation of Arm 98 �8 �� 5 132X08 Amputation of Hand � 249 400 �20 �6� 4 132X09 Amputation of Leg 4 958 80� �44 �22 6 227X�0 Amputation of Foot 66� 49 2� �7 752X�� Amputation of Toe 4 886 509 269 ��2 5 796

15 UK Upper and lower Primary Amputations : 2004/05Tabl

e



Age profile of younger people referred to prosthetics service centres

15a Number of referrals aged under 16 by age group and year April 1997 to March 2005Cha

rt

0

50

100

150

200

250

< 6 108 118 137 127 110 87 99 99

6-11 35 44 42 36 44 28 30 27

12-15 25 52 30 31 44 39 28 40

Total <16 168 214 209 194 198 154 157 166

0

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100

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200

250

2004/052003/042002/032001/022000/011999/001998/991997/98

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15b Percentage of referrals aged under 16 by age group : April 1997 to March 2005Cha

rt

Percentage

Less than 6 years 61%

6-11years20%

12-15 years 20%

The charts below provide information on the age profile of younger people referred to prosthetics service centres. On average referrals for those aged under �6 account for � per cent of all referrals to prosthetics service centres. However the need for support for these patients extends to a much longer time frame than other patients.

The number of referrals aged under �6 has fallen over time from 2�4 in �998/99 to �66 in 2004/05. Consistently over time the majority of children referred are less than 6 years old at the time of referral. In recent years there has been a decline in the number of children aged under 6 from ��7 in �999/00 to 99 in 2004/05. There are no significant changes within the other age groups. On average children aged under 6 years old account for 6� per cent of referrals aged under �6 from �997 – 2005.

Percentages do not add up to �00 % because of rounding.



Referrals following amputation because of dysvascularity

The chart below presents information from �997 to 2005 on referrals where the cause of amputation has been recorded as dysvascularity. There are �� codes within NASDAB which can be used to describe the type of dysvascularity, and for the purposes of this analysis they have been grouped into the following 4 categories:

i) Diabetes Mellitus

ii) Non-diabetic Arteriosclerosis

iii) Those where no detail is given on the type of dysvascularity - No Additional Detail

iv) All other types of dysvascularity grouped together ie. Embolism, Buergers Disease, etc. - Other Dysvascularity

The number of referrals following amputation because of diabetes and non-diabetic arteriosclerosis have significantly increased over the last 8 years. Some of this increase may be attributed to improved data recording as the use of “Dysvascularity : no additional detail” has reduced. The trends for non–diabetic arteriosclerosis and no additional detail are beginning to flatten which may indicate a levelling off. However the number of referrals where diabetes is recorded as the cause of amputation continues to rise.

The NASDAB steering group are undertaking further analysis in this area and will publish findings on the NASDAB website.

DiabetesMellitus 579 693 979 1220 1247 1386 1310 1495

Non-diabetcArteriosclerosis 507 788 848 1062 1124 1173 1004 1035

No Additional Detail 941 1117 1014 1012 956 953 836 858

OtherDysvascularity 259 277 242 201 198 247 232 219

0

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2004/052003/042002/032001/022000/011999/001998/991997/98

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16 Number of new referrals following amputation as a result of dysvascularity by year April 1997 to March 2005

Cha

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APPeNDICeS


Field Name Patient Number Date of Birth Commissioning Code Centre Code Gender Category of patientEthnic Origin

Left Upper Limb Amputation Details Date of Referral following a Left Upper Amputation Date of Amputation Level of Amputation Cause of Amputation (Aetiology)

Left Lower Limb Amputation Details Date of Referral following a Left Lower AmputationDate of Amputation Level of Amputation Cause of Amputation (Aetiology)

Right Upper Limb Amputation Details Date of Referral following a Right Upper Amputation Date of Amputation Level of Amputation Cause of Amputation (Aetiology)

Right Lower Limb Amputation Date of Referral following a Right Lower AmputationDate of Amputation Level of Amputation Cause of Amputation (Aetiology)

Appendix 1

Minimum Dataset Fields

Detailed below is the NASDAB minimum dataset. Further information on each of the data items and data recording guidance is detailed on the website www.nasdab.co.uk


Appendix 2

List of Level and Cause of Amputation Codes

Level of Amputation — Codes used in the Minimum Dataset

Upper Limb 0� Forequarter02 Shoulder Disarticulation0� Trans-humeral04 Elbow Disarticulation05 Trans-radial06 Wrist Disarticulation07 Partial Hand08 Digits

Cause of Amputation (Aetiology) — Codes used in the Minimum Dataset

Trauma �.0 No Additional Detail�.� Mechanical�.2 Electrical�.� Thermal�.4 Chemical Dysvascularity 2.0 No Additional Detail2.� Diabetes Mellitus2.2 Non-diabetic Arteriosclerosis2.� Embolism2.4 Vasospatic Conditions (inc. Raynaud’s)2.5 Disseminated Intravascular Coagulation2.6 Endovascular Chemical Trauma (= Substance Abuse)2.7 Buerger’s Disease2.8 Iatrogenic Vascular Trauma2.9 Arteritis (inc. Rheumatoid Arthritis, Autoimmune Disease)2.A Venous Disease Infection �.0 No Additional Detail�.� Acute�.2 Chronic Neurological Disorder 4.0 No Additional Detail4.� Diabetic Neuropathy 4.2 Infective (inc. Leprosy, Madura Foot)4.� Spina Bifida4.4 Poliomyelitis4.5 Peripheral Nerve Injury Neoplasia 5.0 No Additional Detail5.� Benign5.2 Malignant - Primary5.� Malignant - Secondary Congenital Absence 6.� Congenital absence – no amputation 6.2 Congenital anomaly – surgical amputation Other 7.0 No Additional Detail

Lower Limb 09 Hemi-pelvectomy�0 Hip Disarticulation�� Trans-femoral�2 Knee Disarticulation�� Trans-tibial�4 Ankle Disarticulation (Syme)�5 Partial Foot�6 Digits


Appendix 3

List of Prosthetics Service Centres Submitting Data

Location Centre Name Aberdeen Mobility and Rehabilitation Service Belfast Belfast Disablement Services Centre Birmingham West Midlands Regional Rehabilitation Centre Bristol Disablement Services Centre Cambridge Addenbrookes Disablement Services Centre Cardiff Rookwood Artificial Limb and Appliance Centre Carlisle Carlisle Disablement Services Centre Cleveland Cleveland Disablement Services Centre Derby Derby Amputee Rehabilitation Centre Dorset Dorset Prosthetics CentreDundee Tayside Orthopaedic Rehabilitation Technology Centre Edinburgh Rehabilitation Engineering Services Exeter Exeter Mobility Centre Gillingham Gillingham Disablement Services Centre Glasgow (Strathclyde University) University of Strathclyde Glasgow (Westmarc) Westmarc Hull Hull & East Yorkshire Artificial Limb Unit Inverness Orthotics and Limb Fitting Services Isle of Wight The Prosthetics, Orthotics and Podiatry Department Leeds Specialist Rehabilitation Services Leicester Leicestershire Disablement Services Centre Liverpool (Fazakerley) Prosthetic and Wheelchair Centre at University Hospital AintreeLondon (Bowley Close)* Bowley Close NHS Trust Rehabilitation CentreLondon (Charing Cross) Holderness Limb Fitting Centre London (Harold Wood) Harold Wood Disablement Services Centre London (Roehampton) Roehamptom Rehabilitation Centre London (Stanmore) Stanmore Disablement Services Centre Luton & Dunstable Luton & Dunstable Limb Fitting CentreManchester Manchester Disablement Services Centre Newcastle Newcastle Disablement Services Centre Northampton Northampton Artificial Limb Service Norwich Norwich Disablement Services Centre Nottingham Nottingham Mobility Centre Oxford Oxford Centre for Enablement Plymouth Plymouth Disablement Services Centre Portsmouth Portsmouth Disablement Services Centre Preston Preston Disablement Services Centre Sheffield Sheffield Mobility and Specialised Rehabiliation Centre Stoke North Midlands Amputee Rehabilitation Centre Sussex Sussex Rehabilitation Centre Swansea Swansea Artificial Limb and Appliance Service Wirral Wirral Limb Centre Wolverhampton Maltings Mobility Centre Wrexham North Wales Artificial Limb and Appliance Centre

* previously referred to as London (King's)

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