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?