Cost to the NHS of accidents to children in the West Midlands

The importance of minor injury

The public health approach to injury control is now widely accepted. Since the development of this approach, there has been a shift in the perspective of public health programs to include broader definitions of health. There have also been increasing efforts to evaluate public health interventions in terms of health outcomes at the population level. In this context, it might be appropriate to broaden the focus of injury prevention to target more specifically injuries that are not life-threatening. Although they are not responsible for major morbidity at an individual level, they probably account for the greatest decrement in the health of the population as a whole.

The Minor Injury Scale

OBJECTIVE

To develop an injury scoring system suitable for non-life-threatening injuries.

METHODS

A prospective cohort study was conducted using a representative sample of 1,396 injured adults to identify the outcomes of a range of injuries. Data were collected between March 12, 1992, and March 11, 1993, in the Australian Capital Territory, a geographically circumscribed urban community of 296,000 people served by two hospital EDs. Outcomes included "injury-related health status immediately following injury occurrence" and "accumulated health loss over the period of recovery." The injury-related health status of each subject at the time of the injury occurrence was measured using the Health Consequences of Injury Questionnaire (HCIQ), which records this outcome as a value on a unitary scale. Injuries were then stratified by injury type, as identified by the Abbreviated Injury Scale numerical identifiers. The median health index value for each type of injury was designated the injury severity score for that injury type. The "accumulated health loss over time until recovery" for each injury was calculated from repeated administrations of the HCIQ over a six-month follow-up period, and the median outcome value for each injury type was designated the injury morbidity score for that injury.

RESULTS

Injury severity scores for 46 types of minor injury and injury morbidity scores for 39 types of minor injury were tabulated to form the Minor Injury Scale.

CONCLUSION

This new injury scoring system provides a means of categorizing minor injury according to properties relevant to a public health approach to injury control. Expansion of the number of injury types scored requires further work, as does the testing of the results obtained to confirm the predictive power of the scales.

General practitioners' beliefs about their role in the prevention and treatment of accidents involving children

This questionnaire survey set out to determine the perceptions of family doctors in north Staffordshire regarding their role in the prevention and treatment of childhood accidents. Of 277 doctors sent questionnaires, 207 (75%) replied. Only 23% of respondents considered that they did enough child accident prevention work; lack of time was mentioned as a limiting factor by 66%. Child health surveillance clinics and home visits were considered by 60% and 59% of respondents, respectively, to be appropriate occasions on which to give prevention advice. However, only 12% of respondents frequently gave safety advice while visiting a child. Significantly more older general practitioners (over 44 years) gave advice during a visit than younger doctors. Among doctors with a health visitor who was practice rather than geographically based significantly more gave advice on a home visit and discussed safety issues with their health visitors. Significantly more general practitioners in practices more than five miles from the nearest accident and emergency department offered to provide treatment for children following an accident than those in practices nearer to a hospital. Child accident prevention has recently been targeted as an important area for health promotion in primary care. However, this district based survey has identified a relatively low profile for the subject in the everyday activities of the general practitioner. The need for further research to determine the precise role of the family doctor in the prevention and treatment of children's accidents is highlighted.

Injury surveillance: a key to effective control of childhood injuries

Injuries account for 50% of deaths in Australian children aged 1-14 years, and are a major cause of hospital admission and disability. Injury surveillance systems involving the establishment of ongoing, systematic collection and analysis of data relevant to injury prevention and trauma management have a critical role in the effective control of the injury pandemic. Contemporary Australian initiatives including the establishment of the National Injury Surveillance and Prevention Project, new national public health programmes and research initiatives have the potential to establish a new wave of injury control programmes on a firm scientific base.