National Public Health Service for Wales
Unintentional childhood injuries in Wrexham
Unintentional Injuries in Children
in Wales
(with a particular emphasis on Wrexham
children aged 0 to 4)
Key Messages


Injuries are a worldwide and all-Wales public health concern.
Unintentional injuries are the most common cause of death in children over
one year of age and they leave many more permanently disabled or
disfigured.
 The most vulnerable age groups for injuries occurring at home are the very
young (and older persons age 80+).
 Children in more deprived areas are 5 times more likely to die as a result of
an accident than children from less deprived areas.
 Children aged 0 to 4 years have the most accidents in the home
 Boys are more likely to have accidents than girls
 The high rate of childhood injuries in the home reflects the amount of time
children spend in this environment, particularly 0 to 4 years.
 UK data show the largest number of childhood injuries in the home are
sustained in the living/dining room however, the most serious accidents
happen in the kitchen and on the stairs.
 Most injuries are sustained between late afternoon and early evening, in the
summer, during school holidays and at weekends
 UK data show that the most severe injuries in children are associated with
heat related accidents and falls from a height.
 Young children have a higher percentage of burns and scalds as well as
poisoning and ingestion accidents than older children; the rates for children
aged 0 to 4 are alarmingly high as a result of poisoning/overdose.
 Children account for the highest number of attendances at A&E Departments
with an unintentional injury or poisoning
 The standardised emergency rate for 0-24 year olds admitted to hospital with
an injury or poisoning for Wrexham is lower than the average for Wales.
 Out of children in Wrexham aged 0 to 19 - over a five year period children
who were aged between 0 to 4 in Wrexham accounted for the highest number
of unintentional injury related hospital admissions (however these numbers
are not standardised rates so do not account for the size of the population in
each age group).
 Poorer and overcrowded housing and lack of safe places to play can increase
the risk of injury; these factors are all more common in deprived population
groups.
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Unintentional childhood injuries in Wrexham
Recommendations:
Although the standardised emergency rate for 0-24 year olds admitted to hospital
with an injury or poisoning for Wrexham is lower than the average for Wales, this
is likely to mask the need to address unintentional injuries in the 0 to 4’s. There is
a strong evidence base for addressing unintentional injuries in the 0 to 4’s at an
All-Wales level and at a local (Wrexham) level from an inequalities perspective.
Based on current evidence and data the recommendations are:
1. To target children aged between 0 and 4 in the more deprived areas of
Wrexham (as identified through the most recent deprivation data).
2. Use evidenced based interventions to target the home environment paying
particular attention to:
 Access to poisons, chemicals and medicines
 Burns and scalds
 Heat related accidents
 Falls from a height
3. To maximise effectiveness the above should be delivered through a multiagency partnership approach and complement existing schemes (child safe
scheme in the housing department, communities first).
4. Ensure robust monitoring and evaluation processes are in place for existing
and new schemes in order to maximise effectiveness and impact on children
and their families.
5. Following this report additional information may be obtained at a later date
from NPHS regarding ‘the most effective interventions known to reduce the
incidence of injury to children’ which will support the development and
implementation of local activity.
Refer to Appendix 1 for further information.
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Unintentional childhood injuries in Wrexham
Appendix 1
Introduction
Injuries are a worldwide public health concern. The causes of injuries can be
intentional or unintentional and their outcomes can have significant costs to
individuals, families and health and care services.
Injuries are caused by predictable interactions between individuals and the
environment in which they live and work. The term ‘accident’ is no longer used as
it tends to suggest that injuries are random events and not amenable to
prevention when they usually follow a predictable pattern of exposure and are
largely preventable. Increasingly references are made to unintentional injuries or
events, such as crashes or collisions, rather than terms such as ‘accidental
injury’ or ‘road traffic accident’ (ref: NPHS Needs Assessment 2006 Injuries).
Demography
Mid year population estimates for 2006 show that Wrexham has a total
population of around 131,900.
Children & Young People in Wrexham
The table below shows the number (in thousands) of children in North Wales.
Mid year population estimates, 2006, all persons, North Wales (thousands)
Age group
Area
0-4
5-9
10-14
15-19
Isle of Anglesey
3.5
3.9
4.4
4.4
Gwynedd
6.0
6.9
7.4
7.9
Conwy
5.4
6.0
6.7
7.0
Denbighshire
4.9
5.5
6.0
6.2
Flintshire
8.2
8.9
9.6
9.7
Wrexham
7.4
7.7
8.0
8.3
Source: ONS/HIAT
The chart below show the proportion of the population aged 0 to 4 years and 5 to
15 years. In Wrexham, 5.7% of the local population are aged 0 to 4 years and
13.3% are aged 5 to 15 years.
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Newport
The Vale of Glamorgan
Caerphilly
Pembrokeshire
Newport
Caerphilly
Merthyr Tydfil
Rhondda Cynon Taff
Bridgend
Cardiff
Wrexham
Torfaen
Flintshire
The Vale of Glamorgan
Swansea
Neath Port Talbot
Blaenau Gwent
Carmarthenshire
Pembrokeshire
Monmouthshire
Isle of Anglesey
Gwynedd
Denbighshire
Powys
0
Blaenau Gwent
Torfaen
Merthyr Tydfil
Monmouthshire
Flintshire
Rhondda Cynon Taff
Bridgend
Powys
Carmarthenshire
Denbighshire
Gwynedd
Wrexham
Neath Port Talbot
Isle of Anglesey
Cardiff
14
Conwy
Conwy
Ceredigion
Proportion (%)
6
Swansea
Ceredigion
Proportion (%)
National Public Health Service for Wales
Unintentional childhood injuries in Wrexham
Proportion of population aged 4 and under, ranked
Wales LHBs, 2006 mid-year estimates
Data source: Of f ice f or National Statistics
8
7
Wales average = 5.4%
5
4
3
2
1
Proportion of population aged 5 - 15, ranked Wales
LHBs, 2006 mid-year estimates
Data s ource : Of f ice f or National Statistics
16
Wales average = 13.5%
12
10
8
6
4
2
Unintentional childhood injuries in Wrexham
National Public Health Service for Wales
Burden of unintentional injuries
Injuries and their consequences produce a heavy burden on society in terms of
short and long term disability, mortality, economic loss and health care costs (ref:
NPHS Needs Assessment 2006 Injuries).
In Wales, injuries account for about three per cent of total deaths, however the
distribution of the age of death in those dying is very different from most other
causes of death with a high proportion of deaths occurring in the young. After the
age of one injury is the first or second leading cause of death in most European
countries, including Wales. When a different measure of counting the impact of
death is used, potential years of life lost (PYLL) before age 75 injuries account
for around 15 per cent of all premature mortality in Wales (ref: NPHS Needs Assessment
2006 Injuries).
Unintentional injury related deaths represent a small proportion of the incidence
of injuries in the population. Many more adults and children sustain non-fatal
injuries.
Epidemiology of non-fatal unintentional injuries in children
Unintentional injuries are the most common cause of death in children over one
year of age and they leave many more permanently disabled or disfigured.
Children are at high risk of sustaining an injury as they are often absorbed in their
own immediate interests and can be oblivious to their surroundings; they only
have limited perception of the environment because of their lack of experience or
development (ref: RoSPA website http://www.rospa.com/homesafety/advice/child/accidents.htm#injuries).
Data shows that children aged 0 to 4 years have the most accidents in the home
and boys are more likely to have accidents than girls (ref: Consumer Safety Unit. 24th Annual
Report. Home Accident Surveillance System. London: Department of Trade and Industry, 2002).
Amongst children, UK data shows that the most severe injuries are associated
with heat related accidents and falls from a height. Older children are more likely
to sustain fractures than younger children (ref: Consumer Safety Unit. 24th Annual Report. Home
Accident Surveillance System. London: Department of Trade and Industry, 2002) and young children have a
higher percentage of burns and scalds as well as poisoning and ingestion
accidents.
UK data show the largest number of childhood injuries in the home are sustained
in the living/dining room (ref: Consumer Safety Unit. 24th Annual Report. Home Accident Surveillance System.
London: Department of Trade and Industry, 2002). However the most serious accidents happen
in the kitchen and on the stairs. Every year over 67,000 children experience an
accident in the kitchen, 64% of these involve children aged between 0 to 4 years;
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Unintentional childhood injuries in Wrexham
58,000 children have accidents on the stairs (ref: Consumer Safety Unit. 24th Annual Report. Home
Accident Surveillance System. London: Department of Trade and Industry, 2002).
Most injuries are sustained between late afternoon and early evening, in the
summer, during school holidays and at weekends. Factors such as death in the
family, chronic illness, homelessness or moving home can increase the likelihood
of
a
child
having
an
accident
(ref:
RoSPA
website
http://www.rospa.com/homesafety/advice/child/accidents.htm#injuries ).
Accident & Emergency Department data
The following information uses the available Accident and Emergency
Department data from the All Wales Injury Surveillance System (AWISS) to
describe the incidence of unintentional injuries in Wales. The data can be used to
begin to develop a picture of the incidence of injuries as it highlights the groups
at risk, the type of injuries sustained and where they are occurring. The dataset
does not however include all injuries are some individuals may seek medical
attention elsewhere such as a GP surgery or they may not seek any medical
attention.
Data for hospital utilisation are based on accident and emergency attendances at
the following hospitals:
 Caerphilly Miners Hospital
 Royal Gwent Hospital, Newport
 Nevill Hall Hospital, Abergavenny
 Morriston Hospital Swansea
 Ysbyty Glan Clwyd, Rhyl
and have been extrapolated up to Wales data using an All Wales Injury
Surveillance System (AWISS) / Sitreps injuries extrapolation factor (ref:NPHS Needs
Assessment 2006 Injuries).
Age group
The chart and table below show that the age groups that visit hospital accident
and emergency departments in Wales are typically children, young adults and
the elderly.
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Unintentional childhood injuries in Wrexham
National Public Health Service for Wales
Estimated injury rate, persons by age, Wales, 2004
Source: AWISS
Rate per 1,000 population
300
250
200
150
100
50
85+
80-84
75-79
70-74
65-69
60-64
55-59
50-54
45-49
40-44
35-39
30-34
25-29
20-24
15-19
10-14
5-9
0-4
0
Age
Estimated number of injuries, all persons, Wales, 2004
Estimated Injuries
Estimated Injury Rate
Age
per 1,000 population
0-4
24,560
182
5-9
27,197
156
10-14
47,338
241
15-19
46,395
229
20-24
39,104
187
25-29
30-24
35-39
40-44
45-49
29,002
28,878
28,611
26,306
19,338
157
141
127
116
96
50-54
55-59
60-64
65-69
70-74
16,583
16,190
11,706
9,391
9,212
85
77
68
63
72
75-79
80-84
85+
Unknown
8,942
9,371
12,493
88
82
109
184
Source: AWISS
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Unintentional childhood injuries in Wrexham
National Public Health Service for Wales
Main diagnoses
The chart below shows the most common types of injuries resulting in accident
and emergency attendances in 2004 were sprains, fractures, bruise/abrasion and
laceration/wound.
All injuries by main diagnosis, persons, Wales: 2004
Source : AWISS
35
Rate per 1,000 population
30
25
20
15
10
Main diagnosis, all injuries, all persons, Wales, 2004
Injury
Estimated rate per
1,000 population
Laceration/wound
20
Dislocation
2
Bruise/abrasion
21
Sprains
33
Tendon injury
1
Other soft tissue injury
Foreign body
Bite
Fracture
Burn
9
4
2
24
2
Poisoning/overdose
Head injury
Other injury
9
3
2
Source: AWISS
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Sprains
Fracture
Bruise / abrasion
Laceration / wound
Poisoning / overdose
Other soft tissue
Foreign body
Head
Other injury
Burn
Bite
Dislocation
0
Tendon
5
Unintentional childhood injuries in Wrexham
National Public Health Service for Wales
Sprains – age distribution
Older children and young adults were the age groups more likely to attend
accident and emergency departments in Wales with a main diagnosis of ‘sprain’
in 2004.
Sprains, all persons, Wales, 2004
Source: AWISS
Age specific rate per 1,000 population
80
70
60
50
40
30
20
10
85+
80-84
75-79
70-74
65-69
60-64
55-59
50-54
45-49
40-44
35-39
30-34
25-29
20-24
15-19
10-14
5-9
0-4
0
Age
Fractures – age distribution
The age-specific rates for persons attending accident and emergency
departments with a major diagnosis of fractures is similar to that seen for sprains
for the younger age bands, as it peaks at 10-14 year-olds.
Fracture, all persons, Wales, 2004
Source: AWISS
Age specific rate per 1,000 population
70
60
50
40
30
20
10
Age
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85+
80-84
75-79
70-74
65-69
60-64
55-59
50-54
45-49
40-44
35-39
30-34
25-29
20-24
15-19
10-14
5-9
0-4
0
Unintentional childhood injuries in Wrexham
National Public Health Service for Wales
Bruise/abrasion and laceration/wound – age distribution
The age-specific rates for people attending accident and emergency departments
in Wales in 2004 with a main diagnosis of either bruise/abrasion or
laceration/wound were very similar for persons aged 20 and over. However, the
patterns for children were quite different i.e. lacerations/wounds were more
common amongst children under 5 years of age whereas children aged 10-19
years had higher rates for bruise/abrasions.
Laceration/wound and bruise/abrasion,
all persons, Wales, 2004
Source: AWISS
50
Age specific rate per 1,000
population
45
40
35
30
25
20
15
10
5
Age
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85+
80-84
75-79
70-74
65-69
60-64
55-59
50-54
45-49
40-44
35-39
30-34
25-29
20-24
15-19
10-14
5-9
0-4
0
Unintentional childhood injuries in Wrexham
National Public Health Service for Wales
Poisoning/overdose – age distribution
Age-specific rates for accident and emergency attendances at hospitals in Wales
in 2004 reveal the most vulnerable groups for this type of injury to be young
children and the elderly. The rates for children aged 0-4 are alarmingly high, with
almost five per cent of children in this age group attending an accident and
emergency department as the result of poisoning/overdose.
Poisoning/overdose , all persons, Wales, 2004
Source: AWISS
Age specific rate per 1,000 population
50
45
40
35
30
25
20
15
10
5
Age
Childhood burns and scalds
Whilst burns and scalds form a relatively low proportion of all injuries they are
often quite severe injuries and may result in residual disfigurement and disability.
Scalds are a particular problem in young children and most hospital admissions
in those aged 0-4 years from thermal injuries are due to scalds. Half of these
injuries are due to spilling hot drinks on the child and a quarter are due to
excessively hot tap water (ref: NPHS Needs Assessment 2006 Injuries).
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85+
80-84
75-79
70-74
65-69
60-64
55-59
50-54
45-49
40-44
35-39
30-34
25-29
20-24
15-19
10-14
5-9
0-4
0
Unintentional childhood injuries in Wrexham
National Public Health Service for Wales
Main location
AWISS data relating to the location of injuries shows that most people are injured
at home. Age-specific rates for all injuries for 2004 show that the most vulnerable
age groups for injuries occurring at home are the very young and older persons.
Rates for people injured in road traffic incidents peak in the 15-24 age group,
whilst rates for people injured in public places peak in the early teenage years.
The high rate of childhood injuries in the home reflects the amount of time
children spend in this environment, particularly 0 to 4 year olds. The pattern of
risk changes as children become older and more independent.
Location of injuries, all persons, Wales: 2004
Source: AWISS
120
Home
Road traffic incidents
Public
Rate per 1,000 population
100
80
60
40
20
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85+
80-84
75-79
70-74
65-69
60-64
55-59
50-54
45-49
40-44
35-39
30-34
25-29
20-24
15-19
10-14
5-9
0-4
0
Unintentional childhood injuries in Wrexham
National Public Health Service for Wales
Unintentional injury related hospital admissions
The following charts show children and young people admitted to hospital either
as inpatients or daycases. The data do not include A&E attendances. The
analysis based on counts of individuals, rather than activity.
Children aged 0 to 15 years
The chart below shows the trend in unintentional injury related admissions to
hospital for residents in Wrexham 19 and under. The data are also shown in the
table below.
Unintentional injury related hospital admissions, children aged 0 to 19
years, Wrexham 1999 to 2003
Source: PEDW/CAPIC
0-4
5-9
10-14
15-19
140
Number of admissions
120
100
80
60
40
20
0
1999
2000
2001
2002
Year
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2003
National Public Health Service for Wales
Unintentional childhood injuries in Wrexham
The table below shows that over the 5 year period, children aged 0 to 4
accounted for the highest number of unintentional injury related hospital
admissions. However, these are numbers and not standardised rates, therefore
they do not account for the size of the population in each age group.
Unintentional injury related hospital admissions, children aged 0 to 15
years, Wrexham 1999 to 2003
Age
1999
2000
2001
2002
2003
Total
group
19992003
0-4
133
127
95
128
93
576
5-9
102
105
77
85
81
450
10-14
96
83
114
96
106
495
15-19
77
88
66
95
71
367
Source: PEDW/CAPIC
Children & young people aged 0 to 24 years
Injury and poisoning accounts for around 15 per cent of all person-based
admissions among 0 to 24 year olds.
Rate per 1,000
The chart below shows how hospital admissions for injury and poisoning vary
with age in Wales. Rates are highest in under 5s and lowest in the 5 to 9 age
group.
People aged 0-24 admitted to hospital on an emergency
basis for injury or poisoning, age-specific rate per 1,000,
Wales, 2005 Data source: PEDW
200
175
150
125
100
75
50
25
0
0-1
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1-4
5-9
10-14
Age group
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20-24
Unintentional childhood injuries in Wrexham
National Public Health Service for Wales
The chart below shows the person based standardised emergency admission
rate for 0-24 year olds where the principal diagnosis is injury and poisoning for
Wales between 1999 and 2005. The chart shows that the rate has remained
stable over the period shown (ref: NPHS Needs Assessment 2006 Injuries).
People aged 0-24 admitted to hospital on an emergency
basis for injury or poisoning, EASR per 100,000, Wales,
1999-2005
Data source: PEDW
1400
EASR per 100,000
1200
1000
800
600
400
200
0
1999
2000
2001
2002
2003
2004
2005
The chart below shows the person based standardised emergency admission
rate for 0-24 year olds where the principal diagnosis is injury and poisoning for
LHBs in 2005. There were a total of 618 individuals aged 0 to 24 years admitted
as an emergency due to an injury or poisoning. The standardised rate for
Wrexham is lower than the average for Wales 1,167 compared to 1,209 per
100,000 population aged 0 to 24 years.
People aged 0-24 admitted to hospital on an emergency basis for
injury or poisoning , EASR per 100,000, LHBs, 2005
Data s ource : PEDW
Compared with Wales
Signif icantly Higher
Higher
2000
Low er
Signif icantly Low er
1800
EASR per 100,000
1600
1400
Wales rate = 1209
1200
1000
800
600
400
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Merthyr Tydfil
Blaenau Gwent
Conwy
Gwynedd
Isle of Anglesey
Denbighshire
Swansea
Pembrokeshire
Flintshire
Rhondda Cynon Taff
Caerphilly
Ceredigion
Neath Port Talbot
Wrexham
Torfaen
Monmouthshire
Carmarthenshire
Powys
Newport
Bridgend
Cardiff
0
The Vale of Glamorgan
200
National Public Health Service for Wales
Unintentional childhood injuries in Wrexham
Inequalities in unintentional injuries
Childhood injuries are closely linked with social deprivation. Children from poorer
backgrounds are 5 times more likely to die as a result of an accident than
children from better off families (ref: Department of Health. Our healthier nation: a contract for health.
Consultation Paper. London: The Stationery Office, 1998). Poorer and overcrowded housing and
lack of safe places to play can increase the risk of injury; these factors are all
more common in more deprived population groups.
Deprivation scores in Wrexham
The map below shows the Townsend Deprivation Score for each of the 47
electoral division areas in Wrexham. There are 13 electoral division areas ranked
in the most deprived fifth of deprivation in Wales; nine are in the least deprived
fifth.
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Unintentional childhood injuries in Wrexham
Child poverty indicators
The map below shows the percentage of children aged under 16 years living in
households dependent on worklessness benefits. Wrexham has 4 electoral
division areas where there are between 40 to 60 % of children under 16 living in
such households.
Percentage of children aged under 16 living in households dependent on
worklessness benefits by electoral division: 2005
Crown copyright material is reproduced with the permission of the Controller of HMSO and the Queen’s Printer for Scotland
The map below shows the percentage of dependent children in lone parent
families. 23 electoral divisions have between 10 and 20 percent of dependent
children living in such households. There are 3 electoral divisions with between
40 and just over 55 percent living in lone parent households.
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Unintentional childhood injuries in Wrexham
Percentage of dependent children in lone parent families by electoral
division: 2001
Crown copyright material is reproduced with the permission of the Controller of HMSO and the Queen’s Printer for Scotland
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Unintentional childhood injuries in Wrexham
Appendix One: Data Sources (ref: NPHS Needs Assessment 2006 Injuries)
Accident & Emergency
Department data
The All Wales Injury Surveillance System (AWISS) is funded
by the Welsh Assembly Government to collect information
on all injured people attending A&E departments across
Wales in order to support research into the targeting and
evaluation of injury prevention initiatives. AWISS does not
yet cover all of Wales but the Welsh Assembly Government
will be taking steps to correct this.
Work on this database has confirmed a strong effect of
distance to hospital on attendance rates, such as that for
child attendance rates, for those living within a mile of the
hospital are double those 10 miles away. This holds for all
injuries with the exception of fractures. The reason for this is
that minor injuries can be ignored, self-treated or treated by
other health professionals such as general practitioners and
physiotherapists. This means that comparing small area
maps of many types of injury using A&E data can be
misleading. Before and after comparisons within a particular
area are far less misleading. The data supplied to AWISS is
based on that used to treat injured people in A&E
departments and has limited information on the location,
causes and mechanism of injury i.e. factors that are more of
interest to injury prevention practitioners (CAPIC, 2005).
Hospital activity data
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The source of hospital activity data presented within this
report is the Patient Episode Database for Wales (PEDW).
PEDW is managed by Health Solutions Wales (HSW) and
provides an electronic record of all inpatient and daycase
activity for Welsh residents in NHS hospitals in England and
Wales and for patients treated in Welsh Trusts (HSW,
2006a). Records within PEDW are based on finished
episodes of care under a particular consultant in one health
care provider (FCEs). Multiple FCEs may occur within one
hospital provider spell (or stay in hospital).
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