Unintentional injuries among children under five years

Unintentional injuries among children under five years

• Hospital Episode Statistics (HES) and mortality statistics for the most recent five years

• Other datasets may be useful to allow in-depth study of the topic, for example

− Trauma Audit and Research Network (TARN)

− UK National Burn Injury Database

− Information from child death overview panels (CDOPs)

− Coroners’ data

• These other datasets may comprise small sample sizes, but contain very detailed information on the most serious injuries

• They may provide narrow topic coverage

2 Unintentional injuries among children under five

Datasets

• England

• 2008/09–2012/13 (five years)

• Emergency hospital admissions only

• Data for the under 25s but main focus is on the under fives

• ICD-10 codes W00-X59− Non-transport accidents− Unintentional injuries

• Not just home accidents


Admissions to hospital

• Location codes incomplete


• May need more detail to allow most effective prevention programmes to be identified

• Millions of A&E attendances annually

− not life-threatening but numerous and costly

− potentially distressing and disruptive for the child and family


Some data issues

Location

Home 32%

Residential institution 0%

School 8%

Sports 7%

Street / highway 3%

Trade / service area (shops, etc) 2%

Industrial / construction 1%

Farm 0%

Other 7%

Unspecified 40%

Unintentional injuries among children under five

Distribution of emergency hospital admissions for unintentional injuries (ICD-10 W codes only) among under 25s, by location, 2008/09–2012/13

Source: Hospital Episode Statistics (HES). Copyright © 2014 Re‐used with the permission of The Health and Social Care Information Centre. All rights reserved.


Numbers of home and leisure A&E attendances in the UK, by age (HASS and LASS national estimates), 2002


0 1 2 3 4 5 6 7 8 9 10 11 12 13 140

20,000

40,000

60,000

80,000

100,000

120,000

140,000

160,000

Home Leisure

Age (years)

Nu

mb

er


Numbers of emergency hospital admissions for unintentional injuries, by age group and year


0-4 5-9 10-14 15-19 20-240

5,000

10,000

15,000

20,000

25,000

30,000

35,000

40,000

45,0002008/09 2009/10 2010/11 2011/12 2012/13

Age group

Nu

mb

er



Emergency hospital admission rates by deprivation quintile for unintentional injuries among under fives, with 95% confidence intervals, 2012/13


Least deprived

Most deprived

0

200

400

600

800

1,000

1,200

1,400

1,600

Ra

te p

er

10

0,0

00



Numbers of emergency hospital admissions for unintentional injuries, by age group, 2012/13


0-4 5-9 10-14 15-19 20-24 0-24

Falls 18,286 11,980 9,691 6,065 6,776 52,798

Exposure to inanimate mechanical forces 8,028 4,051 3,440 4,297 5,393 25,209

Exposure to animate mechanical forces 1,326 1,505 1,772 1,931 2,200 8,734

Accidental drowning and submersion 105 33 16 13 10 177

Other accidental threats to breathing 413 72 59 67 96 707

Exposure to electric current, etc 33 14 20 26 60 153

Exposure to smoke, fire and flames 106 79 61 87 111 444

Contact with heat and hot substances 2,215 291 174 127 201 3,008

Contact with venomous animals & plants 25 21 12 10 31 99

Exposure to forces of nature 31 7 18 27 25 108

Accidental poisoning 5,105 513 623 1,864 2,233 10,338

Overexertion, travel and privation 143 183 449 503 616 1,894

Other and unspecified factors 3,307 1,068 978 1,148 1,498 7,999

Total 39,123 19,817 17,313 16,165 19,250 111,668



Emergency hospital admission rates for unintentional injuries among under fives, by sex and year



2008/09 2009/10 2010/11 2011/12 2012/130

200

400

600

800

1,000

1,200

1,400

1,600Males Females

Year

Ra

te p

er

10

0,0

00

45%

45%45% 45%

45%


0-4 5-9 10-14 15-19 20-24 0-24

Falls 18,286 11,980 9,691 6,065 6,776 52,798

Exposure to inanimate mechanical forces 8,028 4,051 3,440 4,297 5,393 25,209

Exposure to animate mechanical forces 1,326 1,505 1,772 1,931 2,200 8,734



Exposure to electric current, etc 33 14 20 26 60 153


Contact with heat and hot substances 2,215 291 174 127 201 3,008

Contact with venomous animals & plants 25 21 12 10 31 99

Exposure to forces of nature 31 7 18 27 25 108

Accidental poisoning 5,105 513 623 1,864 2,233 10,338

Overexertion, travel and privation 143 183 449 503 616 1,894

Other and unspecified factors 3,307 1,068 978 1,148 1,498 7,999

Total 39,123 19,817 17,313 16,165 19,250 111,668



Numbers of emergency hospital admissions for unintentional injuries by age group, 2012/13


Emergency hospital admission rates due to unintentional injuries among under fives, by year, with 95% confidence intervals


2008/09 2009/10 2010/11 2011/12 2012/130

200

400

600

800

1,000

1,200

1,400

Year

Ra

te p

er

10

0,0

00



Major causes of emergency hospital admission for unintentional injuries among under fives, 2008/09–2012/13


Falls 93,315

Impacts, entrapments, lacerations 40,558

Accidental poisoning 23,014

Thermal injuries 11,115

Struck or bumped into by a person, and dog bites 6,553

Suffocation and strangulation 2,024

These six causes represent almost 90% of emergency admissions in this age group.



Numbers of emergency hospital admissions for fall injuries among under fives, 2008/09–2012/13


W10 Fall on and from stairs and steps 12,140

W01 Fall on same level from slipping, tripping and stumbling 11,904

W06 Fall involving bed 9,468

W09 Fall involving playground equipment 9,121

W07 Fall involving chair 8,298

W04 Fall while being carried or supported by other persons 7,445

W18 Other fall on same level 7,157

W08 Fall involving other furniture 6,647

W17 Other fall from one level to another 6,312

W13 Fall from, out of or through building or structure 1,901

W03 Other fall on same level due to collision with, or pushing by, another person 1,141

W19 Unspecified fall 10,469





2008/09 2009/10 2010/11 2011/12 2012/130

100

200

300

400

500

600

700

Year

Ra

te p

er

10

0,0

00

Emergency hospital admission rates for fall injuries among under fives, by year, with 95% confidence intervals



Under 1 1 2 3 40

20

40

60

80

100

120

140

160

180

Fall while being carried or supported by other persons

Fall on and from stairs and steps

Age (years)

Ra

te p

er

10

0,0

00


Emergency hospital admission rates for certain falls, by age, with 95% confidence intervals, 2008/09–2012/13



Under 1 1 2 3 40

20

40

60

80

100

120

Fall involving bedFall involving chairFall involving other furniture

Age (years)

Ra

te p

er

10

0,0

00


Emergency hospital admission rates for furniture falls by age, with 95% confidence intervals, 2008/09–2012/13


Numbers of emergency hospital admissions for impacts, entrapments and lacerations among under fives, 2008/09–2012/13


W22 Striking against or struck by other objects 11,400

W23Caught, crushed, jammed or pinched in or between objects

10,930

W44Foreign body entering into or through eye or natural orifice

10,429

W20 Struck by thrown, projected or falling object 2,463

W25 Contact with sharp glass 1,687

W45 Foreign body or object entering through skin 1,443



Numbers of emergency hospital admissions for accidental poisoning among under fives, 2008/09–2012/13


X40Accidental poisoning by and exposure to nonopioid analgesics, antipyretics and antirheumatics

7,090

X44Accidental poisoning by and exposure to other and unspecified drugs, medicaments and biological substances

6,391

X49Accidental poisoning by and exposure to other and unspecified chemicals and noxious substances

3,979

X41Accidental poisoning by and exposure to antiepileptic, sedative-hypnotic, antiparkinsonism and psychotropic drugs, not elsewhere classified

2,114

X46Accidental poisoning by and exposure to organic solvents and halogenated hydrocarbons and their vapours

1,185



Emergency hospital admissions for accidental poisonings among under fives, 2008/09–2012/13






Emergency hospital admission rates for poisonings among under fives, by type of poison and year, with 95% confidence intervals

2008/09 2009/10 2010/11 2011/12 2012/130

20

40

60

80

100

120Medicines Organic solvents Other household chemicals, etc

Year

Ra

te p

er

10

0,0

00



Under 1 1 2 3 40

50

100

150

200

250

Medicines Household chemicals, poisonous plants, etc

Age (years)

Ra

te p

er

10

0,0

00


Emergency hospital admission rates for accidental poisonings by age, with 95% confidence intervals, 2008/09–2012/13


Numbers of emergency hospital admissions for unintentional thermal injuries among under fives, 2008/09–2012/13


X10 Contact with hot drinks, food, fats and cooking oils 4,174

X15 Contact with hot household appliances 2,122

X12Contact with other hot fluids (incl. water heated on stove)

2,104

X11 Contact with hot tap-water 1,110

X16Contact with hot heating appliances, radiators and pipes

984



2008/09 2009/10 2010/11 2011/12 2012/130

10

20

30

40

50

60

70

80

Year

Ra

te p

er

10

0,0

00



Emergency hospital admission rates for unintentional thermal injuries among under fives, by year, with 95% confidence intervals




Emergency hospital admission rates for unintentional scalds among under fives, by year, with 95% confidence intervals

2008/09 2009/10 2010/11 2011/12 2012/130

5

10

15

20

25

30

Hot drinks, food, fats and cooking oils Hot tap-water

Other hot fluids (incl. water heated on stove)

Year

Ra

te p

er

10

0,0

00


2008/09 2009/10 2010/11 2011/12 2012/130

2

4

6

8

10

12

14

16

Hot household appliances Hot heating appliances, radiators and pipes

Year

Ra

te p

er

10

0,0

00



Emergency hospital admission rates for unintentional contact burns among under fives, by year, with 95% confidence intervals



Under 1 1 2 3 40

10

20

30

40

50

60

70

80

Contact with hot drinks, food, fats and cooking oils

Contact with hot tap-water

Contact with other hot fluids (incl. water heated on stove)

Age (years)

Ra

te p

er

10

0,0

00


Emergency hospital admission rates for unintentional scalds by age, with 95% confidence intervals, 2008/09–2012/13



Under 1 1 2 3 40

5

10

15

20

25

30

Contact with hot household appliances

Contact with hot heating appliances, radiators and pipes

Age (years)

Ra

te p

er

10

0,0

00


Emergency hospital admission rates for unintentional appliance burns by age, with 95% confidence intervals, 2008/09–2012/13


Numbers of emergency hospital admissions from exposure to animate mechanical forces among under fives, 2008/09–2012/13


W54 Bitten or struck by dog 2,427

W50Hit, struck, kicked, twisted, bitten or scratched by another person

1,408

W51 Striking against or bumped into by another person 1,392




2008/09 2009/10 2010/11 2011/12 2012/130

2

4

6

8

10

12

14

16

18

Year

Ra

te p

er

10

0,0

00


Emergency hospital admission rates for dog bites among under fives, by year, with 95% confidence intervals


Numbers of emergency hospital admissions for other accidental threats to breathing among under fives, 2008/09–2012/13


W79Inhalation and ingestion of food causing obstruction of respiratory tract

972

W80Inhalation and ingestion of other objects causing obstruction of respiratory tract

439

W78 Inhalation of gastric contents 407




Under 1 1 2 3 40

2

4

6

8

10

12

14

16

Inhalation of gastric contents

Inhalation and ingestion of food causing obstruction of respiratory tract

Inhalation and ingestion of other objects causing obstruction of respiratory tract

Age (years)

Ra

te p

er

10

0,0

00


Emergency hospital admission rates for inhalations and ingestions by age, with 95% confidence intervals, 2008/09–2012/13


Proportions of emergency hospital stays for specific causes that were over three days among under fives, 2008/09–2012/13



Other accidental threats to breathing 14.2%

Exposure to smoke, fire and flames 12.0%

Contact with heat and hot substances 11.8%

Accidental drowning and submersion 9.0%

Falls 3.8%

Accidental poisoning 2.1%

Impacts, entrapments, lacerations 1.7%

All causes 4.5%




Variations in lengths of emergency hospital stay among under fives, 2008/09–2012/13

Under 2 days Over 3 days

2008/09 87.5% 4.9%

2009/10 87.1% 4.8%

2010/11 88.0% 4.3%

2011/12 88.2% 4.2%

2012/13 88.3% 4.4%



• Social inequalities gradient for the under fives

• Drop in overall emergency admission rates in 2012/13

• Falls (93,000)− falls on stairs and steps (one year olds)− drops (under ones)− furniture falls (decrease with age)− drop in falls admissions in 2012/13 but reason not clear

• Bumps, crushing and entrapments (40,500), small objects

Overview of emergency hospital admissions for the under fives


• Poisonings: medicines (16,000). Increasing annual trend. Short lengths of stay.

• Thermal injuries (11,000): scalds and appliance burns (one year olds). No clear annual trend. Long lengths of stay.

• Dog bites (2,400): after age of one. The annual trend is flat.

• Suffocations (2,000): vomit (under ones) and food (both under ones and older). Long lengths of stay.

Overview of emergency hospital admissions for the under fives


• Mortality statistics from the Office for National Statistics

• England

• 2008-2012 inclusive – five years

• ICD-10 codes W00-X59

- Non-transport accidents

- Unintentional injuries


Deaths

Deaths by age group, 2008–2012


0-4 5-9 10-14 15-19 20-24 Total

Falls 24 2 14 53 81 174

Exposure to inanimate mechanical forces 18 5 6 13 36 78

Exposure to animate mechanical forces 3 0 2 3 7 15



Exposure to electric current, radiation , etc 2 0 2 12 22 38


Contact with heat and hot substances 3 1 0 0 0 4

Exposure to forces of nature 0 0 1 6 6 13Accidental poisoning by and exposure to noxious substances 10 4 15 156 461 646Accidental exposure to other and unspecified factors 25 8 2 25 49 109

311 78 121 408 876 1,794

Source: Office for National Statistics. Crown copyright reserved.


Deaths among under fives, 2008–2012


Other accidental threats to breathing 138

Accidental drowning and submersion 65

Falls 24

Exposure to smoke, fire and flames 23

Exposure to inanimate mechanical forces 18

Accidental poisoning by and exposure to noxious substances 10

Exposure to animate mechanical forces 3

Contact with heat and hot substances 3

Exposure to electric current, etc 2

Contact with venomous animals and plants 0

Exposure to forces of nature 0

Overexertion, travel and privation 0

Accidental exposure to other and unspecified factors 25



Distribution of deaths among under fives by sex,2008–2012


Under 1 1 2 3 4 Under 50%

10%

20%

30%

40%

50%

60%

70%Males Females

Age (years)Source: Office for National Statistics. Crown copyright reserved.


Numbers of deaths due to other accidental threats to breathing among under fives, 2008–2012


W75 Accidental suffocation and strangulation in bed 37

W76 Other accidental hanging and strangulation 28

W79Inhalation and ingestion of food causing obstruction of respiratory tract

19

W78 Inhalation of gastric contents 16

W80Inhalation and ingestion of other objects causing obstruction of respiratory tract

7

W83 Other specified threats to breathing 6

W84 Unspecified threat to breathing 25

Total 138



Numbers of deaths due to accidental drowning and submersion among under fives, 2008–2012


W65 Drowning and submersion while in bath-tub 18

W67 Drowning and submersion while in swimming-pool 6

W69 Drowning and submersion while in natural water 2

W70 Drowning and submersion following fall into natural water 2

W68 Drowning and submersion following fall into swimming-pool 1

W66 Drowning and submersion following fall into bath-tub 0

W74 Unspecified drowning and submersion 22

W73 Other specified drowning and submersion 14

Total 65



Numbers of deaths due to falls among under fives, 2008–2012


W04 Fall while being carried or supported by other persons 5

W13 Fall from out of or through building or structure 5

W07 Fall involving chair 3

W06 Fall involving bed 2

W08 Fall involving other furniture 2

W10 Fall on and from stairs and steps 2

W18 Other fall on same level 1

W09 Fall involving playground equipment 0

W19 Unspecified fall 4

Total 24



Numbers of deaths due to exposure to smoke, fire and flames among under fives, 2008–2012


X00 Exposure to uncontrolled fire in building or structure 18

X06 Exposure to ignition or melting of other clothing and apparel 3

X08 Exposure to other specified smoke 1

X09 Exposure to unspecified smoke 1

Total 23



Numbers of deaths due to exposure to inanimate mechanical forces among under fives, 2008–2012


W20 Struck by thrown projected or falling object 10

W22 Striking against or struck by other objects 3

W23 Caught crushed jammed or pinched in or between objects 1

W24 Contact with lifting and transmission devices, not elsewhere classified

1

W29 Contact with other powered hand tools and household machinery 1

W31 Contact with other and unspecified machinery 1

W44 Foreign body entering into or through eye or natural orifice 1

Total 18



Numbers of deaths due to accidental poisoning, among under fives, 2008–2012


X49 Accidental poisoning by and exposure to other and unspecified chemicals and noxious substances

4

X44 Accidental poisoning by and exposure to other and unspecified drugs, medicaments and biological substances

3

X42 Accidental poisoning by and exposure to narcotics and psychodysleptics, not elsewhere classified

2

X40 Accidental poisoning by and exposure to nonopioid analgesics, antipyretics and antirheumatics

0

X41 Accidental poisoning by and exposure to antiepileptic, sedative-hypnotic, antiparkinsonism and psychotropic drugs, not elsewhere classified

1

X45 Accidental poisoning by and exposure to alcohol 0

X47 Accidental poisoning by and exposure to other gases and vapours 0

X48 Accidental poisoning by and exposure to pesticides 0

Total 10




• Suffocation and strangulation in bed (37), other hanging and strangulation (28)

• Inhalation and ingestion of food and inhalation of vomit (42)

• Drowning: bath (18); lack of specified causes (22)

• Falls (24): no single high cause – drops, window and furniture falls. Stair falls infrequent

• House fires (18)

• Mechanical forces (18): possibly cave-ins and collapse of structures

• Poisonings (10): medicines and household chemicals


Overview of deaths among the under fives, 2008–2012

Overview of deaths (2008–2012) and emergency hospital admissions (2008/09-2012/13) among under fives, ordered by deaths


Deaths AdmissionsAdmissions/

deaths

Other accidental threats to breathing 138 2,024 15

Accidental drowning and submersion 65 498 8

Falls 24 93,315 3,888

Exposure to smoke, fire and flames 23 724 31

Exposure to inanimate mechanical forces

18 40,575 2,254

Accidental poisoning by and exposure to noxious substances

10 23,014 2,301

Exposure to animate mechanical forces 3 6,553 2,184

Contact with heat and hot substances 3 11,115 3,705

Exposure to electric current, etc 2 188 94Sources: Office for National Statistics. Crown copyright reserved. Hospital Episode Statistics (HES). Copyright © 2014 Re‐used with the permission of The Health and Social Care Information Centre. All rights reserved.


Overview of deaths (2008–2012) and emergency hospital admissions (2008/09–2012/13) among under fives, ordered by admissions


Deaths AdmissionsAdmissions/

deaths

Falls 24 93,315 3,888

Exposure to inanimate mechanical forces

18 40,575 2,254

Accidental poisoning by and exposure to noxious substances

10 23,014 2,301

Contact with heat and hot substances 3 11,115 3,705

Exposure to animate mechanical forces 3 6,553 2,184

Other accidental threats to breathing 138 2,024 15

Exposure to smoke, fire and flames 23 724 31

Accidental drowning and submersion 65 498 8

Exposure to electric current, etc 2 188 94Sources: Office for National Statistics. Crown copyright reserved. Hospital Episode Statistics (HES). Copyright © 2014 Re‐used with the permission of The Health and Social Care Information Centre. All rights reserved.


Documents

Unintentional injuries among children under five years