presentation on admissions to acute hospitals resulting from rta's
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Presentation on
Admissions to Acute Hospitals Resulting fromRoad Traffic Crashes in Ireland 2005-2009
from
A Sheridan, F Howell, N McKeown, D BedfordDepartment of Public Health
Navan, Co. Meathto
Regional Health Forum – Dublin North East 23rd May, 2011
Key Findings
The study reported 3.5 times for serious injuries than the RSA/Garda data
Two-thirds were male Almost half were aged less than 25 Over half had a hospital stay of 1-2 days Two thirds occurred in “Summer Time” The vast majority were discharged home Significant costs to the health service and the economy
Background
50 million people are injured or disabled in road traffic crashes (RTCs) each year
World Health Organisation
Internationally, statistics on injuries are under-estimated in many countries
Ireland Road deaths at the lowest level since 1959 Statistics on serious injuries from RTCs are unreliable
Road Safety Authority
Definition of a Serious Injury
Road Safety Authority’s Definition of ‘Serious Injury’
“A serious injury is an injury for which the person is detained in hospital as an ‘inpatient’, or any of the following injuries whether
or not detained in hospital: fractures, concussion, internal injuries, crushing’s, severe cuts and lacerations, severe general shock
requiring medical treatment”
Current source of data is An Garda SíochánaLiterature suggests other sources of information should be used
including hospital admissions data, ED attendances and insurance data
Aim of this Study
To explore the use of hospital data as a source of RTC-related injury data in Ireland
Definition of a Serious Injury
Definition of ‘Serious Injury’ in this study:
“A serious injury is an injury for which the person is detained in hospital as an ‘inpatient’,””
Methods
Hospital Inpatient Enquiry System (HIPE) via Health Atlas Ireland (HAI)
Selection Criteria:All discharges admitted as an emergency Any diagnosis of a land transport injury (ICD-10-
AM codes V01-V89)Excluded all non-traffic and unspecified collisionsYears 2005-2009
Results
14,861 RTC-related hospital discharges
7.9% reduction from 2005 to 2009
Year Number of RTC-related discharges
2005 3,080
2006 3,118
2007 2,964
2008 2,862
2009 2,837
Total 14,861
Results by Road User Group
ROAD USER GROUP Number %
Car Occupants 8,974 60.4
Pedestrian 2,453 16.5
Motorcyclist 1,345 9.1
Pedal Cyclist 1,050 7.1
Pick Up Truck/Van/Other
1,039 7.0
Total 14,861 100.0
Profile of the Injured Persons
65% male Average age of 33.1 years
Age-profile of the injured by 5-year age-group, and gender
0
500
1,000
1,500
2,000
5-year age-groups
Num
ber d
isch
arge
s
Male Female
Month of Hospital Admission
Feb-05 Dec-09*
Jul-05
Jul-07
Feb-06
Feb-07
Jun-08
Feb-08
Jul-06
May-09
Feb-09
0
50
100
150
200
250
300
350
400Nu
mbe
r of a
dmis
sion
s
Details of Hospital Episode
Saturdays & Sundays were the most common days of admission
Average length of hospital stay = 6 daysAlmost 60% with LOS of 1-2 days
Total bed days used = 87,750 daysAverage daily occupancy = 48 beds
10.1% required ICU admissionAverage ICU LOS = 7 days
Details of Hospital Episode
Head injuries (31%) were the most common principal diagnosis
ProceduresMost commonly diagnostic and imaging servicesSurgical procedures on the musculoskeletal system 43%
Discharge Outcome:84% discharged home11% transferred to another hospital1.4% died3.6% Other
Trends 2005-2009
Age standardised discharge rate per 100,000 population for RTC-related injuries (excluding fatal injuries), 2005-2009
0
10
20
30
40
50
60
70
2005 2006 2007 2008 2009
Year
Rat
e pe
r 100
,000
pop
ulat
ion
Trends 2005-2009
Age standardised discharge rate per 100,000 population for RTC-related injuries (excluding fatal injuries) by road user group, 2005-2009
0
5
10
15
20
25
30
35
40
45
2005 2006 2007 2008 2009
Rat
e pe
r 100
,000
pop
ulat
ion
Car occupants
Pedestrian
Pedal Cyclist
Motor Cyclist
Patients’ Area of Residence
Average discharge rate ratios, by county of residence (Ireland=1), 2005-2009
0.0
0.5
1.0
1.5
2.0
2.5
Rat
e ra
tio p
er 1
00,0
00 p
opul
atio
n
Rate ratio per 100,000 population Ireland
Comparison with RSA statistics
YEAR SERIOUS INJURIES
RSA DATA
HOSPITAL DISCHARGES
HIPE DATA
RATIO HIPE:RSA
2005 1,021 3,080 3.0
2006 907 3,118 3.4
2007 860 2,964 3.4
2008 835 2,862 3.4
2009 640 2,837 4.4
Total 4,263 14,861 3.5
Given the RSA definition of serious injury also includes those who do not require inpatient admission, the under-reporting of serious injuries in RSA reports is even greater
Ratio of Hospitalised Road Users to Fatally Injured Road Users
YEAR NUMBER OFHOSPITALISATIONS
> 1DAY
NUMBER OF FATAL
INJURIES ^
RATIO HOSPITALISATIONS:
FATAL INJURIES
2005 1,804 396 4.6
2006 1,852 365 5.1
2007 1,703 338 5.0
2008 1,695 279 6.1
2009 1,657 238 7.0
A statistic cited by many countries internationally Hospitalisations with LOS greater than 24 hours, excluding fatal
injuries Irish ratio increasing
Numbers hospitalised not reducing as rapidly as numbers killed Compares favourably internationally
Inpatient Hospital Costs
Cost of Inpatient Hospital Care Calculated using Health Atlas For years 2005-2008 only Costs increased by 12% from €18.1 to €20.3 million Average cost of RTC injury = €6,395
ROAD USER GROUP AVERAGE COST
Motorcyclists € 8,491
Pedestrians € 7,926
Vans/ Trucks/Other € 6,098
Car Occupants € 5,818
Pedal Cyclists € 5,173
Discussion
Study has identified a major under-reporting of serious injuries resulting from RTCs
Other countries have reported similar under-estimationsMultiple data sources provide a more accurate picture of true extent
HIPE is the main data sourceOnly source of morbidity data available nationally on hospital care of
injured personsNo data available from EDs, outpatient departments, private
hospitals or GPsHIPE records episodes of care and does not allow tracking of
patients
Discussion
Seasonal variation in hospitalisationsRequirement for enforcement by An Garda Síochána during summer
monthsCampaigns to highlight road users of the dangers during summer
CostsAverage hospital costs of €6,395Goodbody Consultants estimated cost of a serious injury crash at
€304,600Based on number of serious injuries outlined here, annual cost is
€0.9 billion per year
Recommendations
This hospital data should be reported on as routine in conjunction with An Garda Síochána and other data to provide more realistic and timely injury trends
HSE working with RSA to try and link data sources and provide a more complete picture.
Key Findings
The study reported 3.5 times for serious injuries than the RSA/Garda data
Two-thirds were male Almost half were aged less than 25 Over half had a hospital stay of 1-2 days Two thirds occurred in “Summer Time” The vast majority were discharged home Significant costs to the health service and the economy
QUESTIONS?
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