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?