Injury Surveillance in Scotland: Importance and Implementation Overview
Scotland's Public Health body, Public Health Scotland, leads efforts in injury surveillance to prolong healthy life, prevent disease, and promote health. Long-term investment in prevention involves various sectors. Injury surveillance is crucial as it helps manage and prevent injuries, with coded data playing a key role in maintaining standards and aiding analysis. Clinical coding ensures consistency in diagnoses for effective monitoring and comparison. Understanding the role of injury surveillance and coded data is essential for improving public health outcomes in Scotland.
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Injury Surveillance in Scotland: Injury Surveillance in Scotland: Health Service Contribution Health Service Contribution Stephen Bridgman (Clinical lead for injury), with John Connor, Sandra Storrie, and Emma Doyle Public Health Scotland Cross Party Group on Accident Prevention and Safety Awareness 6thFebruary 2024
Our purpose As Scotland s national public health body, Public Health Scotland leads and supports work to Prolonghealthy life Prevent disease Promote health supporting access to high quality healthcare by providing vaccines and reducing the spread of infectious diseases by strengthening the building blocks of health for all
Long-term investment in prevention: every sector has a role Scottish Government Local Health and Social Care Government Communities and Third Sector Wider Public Sector Business
Outline of Talk Injury surveillance What it is and why is it important? What is clinical coding? ICD coding What is coded data used for Available Health datasets PHS publications Home Injury: Some figures Priorities for improvement?
What is injury surveillance and why is it important? Injury the major cause of death in people under 35y in Scotland Injury the major cause of years of life lost under 75y in Scotland If you cannot measure it you cannot manage it well!
What is clinical coding? Clinicians use many different terms for the same diagnoses when writing clinical notes. When identifying how many patients have a particular condition, text recorded in notes presents difficulties when trying to count and compare diagnoses. Instead, consistent codes are applied for the same condition, making analysis easier.
What is Coded Data Used For? Helps maintain clinical standards Helps with financial control Helps with injury surveillance to help prevent problems
Available Health datasets PHS managed that contain injury data NHS Hospitals Admissions Accident and Emergency Attendances Primary Care In-hours Services Out of Hours Services Pharmacy Scottish Ambulance Service NHS 24
Hospital Admissions Scotland invest in clinical coders who code hospital admissions Coders use World Health Organisation (WHO) International Classification of Diseases codes (ICD 10) for diagnoses, external causes, intent Coders use Office of Population, Censuses and Surveys (OPCS 4) codes for operations Coding of data is good and can be used for National Statistics
Hospital Admissions in Scotland 2021-22 and 2022-23 Year 2021-22 2022-23 Hospital Admissions 1,060,041 1,092,413 Emergency Hospital Admissions 570,857 557,681 Emergency Injury Hospital Admissions c 1 in 100 Scots admitted every year 57,272 54,709
PHS Annual Unintentional Injuries Report 2022-23, events and external causes of injury, Scotland 54,709 emergency admissions for unintentional injuries, about 10% of all emergency admissions In 2022, unintentional injuries led to 2,677 deaths.
Location of hospital admissions for injury caused by a fall (N=36050), Scotland 2022/23, all sexes 34% 46% 20% Home Other Unknown
Hospital admissions for an injury occurring in the home children 0-4years, 2010-11 to 2022-23 (numbers) Unintentional Injuries in the Home, 0-4 years 2500 2129 2100 2000 1992 1966 1889 1830 1822 1661 1643 1617 1500 1426 1400 1309 1200 1173 1148 1087 1084 1038 1017 1000 935 929 927 917 898 882 844 826 815 805 802 792 745 744 726 700 600 585 565 500 0 2010/11 2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18 2018/19 2019/20 2020/21 2021/22 2022/23 Females Males Both
Hospital admissions for an injury occurring in the home, older adults 75y and over, (numbers) Unintentional Injuries in the Home, 75+ years 12000 11355 11279 10914 10500 10152 10000 9725 9389 9146 8761 8501 8491 8075 8054 8000 7602 7586 7523 7272 7232 6900 6749 6720 6424 6414 6349 6000 5715 5465 4000 3312 3280 3225 2977 2880 2825 2640 2426 2337 2142 2087 2000 1871 1767 0 2010/11 2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18 2018/19 2019/20 2020/21 2021/22 2022/23 Females Males Both
Hospital admissions for an injury occurring in the home, main diagnoses, 2022/23 (numbers) Main Diagnoses of Unintentional Injuries in the Home 140.0 120.0 100.0 80.0 60.0 40.0 20.0 0.0 S72 S82 S42 S32 S01 S09 S52 S22 S00 S06 Other Fracture of Lower Leg, Including Ankle 25.9 Other and Unspecified Injuries of Head 18.9 Fracture of Rib(s), Sternum and Thoracic Spine 16.5 Fracture of Shoulder and Upper Arm Fracture of Lumbar Spine and Pelvis Fracture of Femur Open Wound of Head Fracture of Forearm Superficial Injury of Head Intracranial Injury Other rate 77.1 23.9 22.0 19.3 17.6 14.7 10.3 120.9
Hospital admissions for injury from dog bite or strike (W54), occurring in the home, 2013/2014 to 2022/23 (numbers) Dog Injuries in the Home 250 200 150 199 100 194 178 150 149 145 144 144 142 140 50 0 2013/2014 2014/2015 2015/2016 2016/2017 2017/2018 2018/2019 2019/2020 2020/2021 2021/2022 2022/2023 No of (CIS)Continuous Stays(SMR01)
NHS hospital admissions for all unintentional injuries by deprivation quintile, 2022/23 (standardised discharge ratio) 160.0 Standardised discharge ratio: Scotland = 100 140.0 120.0 100.0 80.0 60.0 40.0 20.0 0.0 1 (Most deprived) 2 3 4 5 (Least deprived) Deprivation
What is theoretically possible given the quality and depth of data held. SMR01 Hospital admissions is available from to 1980-2023 More specific causes of injury can be presented e.g. Drownings Exploring presenting more detailed injury location data; Home Residential institute Street and highway School, other institution and public administrative area Sports and athletics area Industrial and construction area Farm Other specified places Unspecified place
Annual Unintentional injuries reports analysis of hospital admissions, and deaths
Annual unplanned emergency department (ED) and minor injury unit (MIU) attendances 2,000,000 1,500,000 1,000,000 500,000 0 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 ED MIU/OTHER Consistently around 1.5/1.6 million attendances each year Proportion of attendances from injury is unknown, as data quality is poor
Accident and Emergency (A&E) data issues & opportunities Issues Different coding systems used by different hospitals Coding usually carried out by front line staff instead of dedicated coders Data quality too poor for PHS to be able to use to publish statistics Opportunities Public Health Scotland have funded 3 very short term pilots to look at improving coding in 3 emergency departments If coding improves then Scotland might use A&E data for prevention
Priorities for improved surveillance A&E Data Needs investment to improve coding so data is usable Will enable targeted prevention Is likely to be an invest to save investment for the public sector overall Is likely to reduce hospital pressures and reduce injury in Scotland https://www.google.com/search?sca_esv=c5c757c13b9f06cb&rlz=1C1GCEB_enGB1047GB1047&sxsrf=ACQVn08Zq6tWbifMmml- uVYo7JMh6CugJg:1707167096335&q=child+injured+from+blinds&tbm=isch&source=lnms&sa=X&ved=2ahUKEwiVoOWCjZWEAxUe9wIHHWc xBtYQ0pQJegQIDBAB&biw=853&bih=373&dpr=2.25#imgrc=VRZXUA8N28DXiM
Thank you! Thank you for listening Any queries or suggestions for improvement or work you may wish done please contact Stephen.bridgman@phs.scot, Consultant in Public Health, Public Health Scotland
Appendix 1 Injury type codes for hospital admissions Injury Type All injuries Road traffic accidents Poisonings Falls Struck by, against Crushing Scalds Accidental exposure Emergency Admission Type* Admission type code 32-35 32 - Patient injury - road traffic accident Admission type code 33-35 Admission type code 33-35 Admission type code 33-35 Admission type code 33-35 Admission type code 33-35 Admission type code 33-35 ICD10 Codes and ICD10 codes V01-X59 Y85-Y86 Number of admission 2022/23 54,709 2,558 2,993 36,050 1,844 962 478 2,643 and ICD10 codes X40-X49 and ICD10 codes W00-W19 and ICD10 codes W20-W22, W50-W52 and ICD10 code W23 and ICD10 code X10-X19 and ICD10 codes X58-X59 and other ICD10 codes in the range V01- X59 Y85-Y86 not included in any of the other categories Other 'All unintentional injures' may not equal the sum of individual injuries as a patient could have had more than one external cause of injury recorded in an emergency admission. Admission type code 33-35 7,381 Emergency Admission Type* 32 - Patient injury - road traffic accident 33 - Patient injury - home incident 34 - Patient injury - incident at work 35 - Patient injury - other injury
