Presentation on Admissions to Acute Hospitals resulting from RTA's

Presentation on

Admissions to Acute Hospitals Resulting from Road Traffic Crashes in Ireland 2005-2009 from

A Sheridan, F Howell, N McKeown, D Bedford Department of Public Health Navan, Co. Meath to

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 underestimated 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 Síochána  Literature suggests other sources of information should be used

including hospital admissions data, ED attendances and insurance data

Aim of this Study

ď Ž 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-10AM codes V01-V89)  Excluded all non-traffic and unspecified collisions  Years 2005-2009

Results ď Ž 14,861 RTC-related hospital discharges Year

Number of RTC-related discharges

2005

3,080

2006

3,118

2007

2,964

2008

2,862

2009

2,837

Total

14,861

ď Ž 7.9% reduction from 2005 to 2009

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 ď Ž 65% male ď Ž Average age of 33.1 years Age-profile of the injured by 5-year age-group, and gender

1,500 1,000 500

Male

59

10 -1 4 15 -1 9 20 -2 4 25 -2 9 30 -3 4 35 -3 9 40 -4 4 45 -4 9 50 -5 4 55 -5 9 60 -6 4 65 -6 9 70 -7 4 75 +

0 04

Number discharges

2,000

Female

5-year age-groups

Month of Hospital Admission 400 Jul-05

350 Jul-07

Jul-06

300

Number of admissions

Jun-08

May-09

250

200

Feb-06 Feb-05

150

100

50

0

Feb-08 Feb-07

Feb-09 Dec-09*

Details of Hospital Episode  Saturdays & Sundays were the most common days of admission  Average length of hospital stay = 6 days  Almost 60% with LOS of 1-2 days

 Total bed days used = 87,750 days  Average daily occupancy = 48 beds

 10.1% required ICU admission  Average ICU LOS = 7 days

Details of Hospital Episode  Head injuries (31%) were the most common principal diagnosis  Procedures  Most commonly diagnostic and imaging services  Surgical procedures on the musculoskeletal system 43%

 Discharge Outcome:  84% discharged home  11% transferred to another hospital  1.4% died  3.6% Other

Trends 2005-2009

Rate per 100,000 population

ď Ž Age standardised discharge rate per 100,000 population for RTC-related injuries (excluding fatal injuries), 20052009 70 60 50 40 30 20 10 0 2005

2006

2007 Year

2008

2009

Trends 2005-2009 ď Ž Age standardised discharge rate per 100,000 population for RTC-related injuries (excluding fatal injuries) by road user group, 2005-2009 45

Rate per 100,000 population

40 35 30

Car occupants

25

Pedestrian

20

Pedal Cyclist Motor Cyclist

15 10 5 0 2005

2006

2007

2008

2009

Patients’ Area of Residence

Rate ratio per 100,000 population

ď Ž Average discharge rate ratios, by county of residence (Ireland=1), 2005-2009 2.5 2.0 1.5 1.0 0.5 0.0

Rate ratio per 100,000 population

Ireland

Comparison with RSA statistics YEAR

SERIOUS INJURIES

HOSPITAL DISCHARGES

RATIO HIPE:RSA

RSA DATA

HIPE DATA

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

ď Ž 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 OF HOSPITALISATIONS > 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-estimations  Multiple data sources provide a more accurate picture of true extent

 HIPE is the main data source  Only source of morbidity data available nationally on hospital care of

injured persons  No data available from EDs, outpatient departments, private hospitals or GPs  HIPE records episodes of care and does not allow tracking of patients

Discussion  Seasonal variation in hospitalisations  Requirement for enforcement by An Garda Síochána during summer

months  Campaigns to highlight road users of the dangers during summer

 Costs  Average hospital costs of €6,395  Goodbody Consultants estimated cost of a serious injury crash at

€304,600  Based 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?