title: How has the Licensing Act (2003) changed the epidemiology of assaults presenting to a Cambridgeshire emergency department? Before and after study.
abstract: BACKGROUND
  The Licensing Act (2003) was implemented in England and Wales at midnight on 23 November 2005. Two studies have tried to assess the impact of the new legislation on emergency department attendances in London and South Yorkshire. Both studies reported a small increase in alcohol-related attendances to the emergency department after the new legislation. This study aimed to assess whether the Licensing Act (2003) has had a significant impact on the number and demography of assaults presenting to a Cambridgeshire emergency department.
  
  
  METHODS
  An observational study was conducted using data obtained from the emergency department of the Addenbrooke's Hospital, Cambridgeshire, UK. The study population included all patients, reported of being assaulted, presenting to the emergency department between 23 November 2001 and 23 November 2009. The primary outcome was a change in the number of assaults presenting before and after the implementation of the Licensing Act (2003). Secondary outcomes included changes in the demographics of assault victims including age, sex, time of presentation and ambulance usage.
  
  
  RESULTS
  In total, 9214 patients presented to the emergency department of the Addenbrooke's hospital, reported of being assaulted, between 23 November 2001 and 23 November 2009. Sixteen of these patients were excluded because of incomplete data collection. Therefore, 9198 patients were included in the subsequent analysis. The study showed an increase in the number of assaults presenting after the implementation of the Licensing Act (2003). The mean annual number of assaults increased from 1083 to 1216. There was a statistically significant trend towards increasing assaults, z=1.95, P=0.05. There was a significant decrease in the number of female assault victims presenting after the new legislation, P value of less than 0.001. There was a slight change in the age profile of female victims, with a greater proportion of victims aged between 18 and 35 years presenting after the Act, P=0.035. The time of peak presentation for assault cases was significantly later in the evening after the implementation of the Act, with the peak time of presentation moving from a sharp peak at 01:00-01.59 to a broad peak between 01:00 and 03:59, (P=0.004). There was a statistically significant increase in the number of assaults presenting at the weekend, P value of less than 0.001. There was no significant change in ambulance usage after the implementation of the Licensing Act.
  
  
  CONCLUSIONS
  The Licensing Act (2003) has been associated with minor changes in the epidemiology of assaults presenting to our emergency department. The magnitude of these changes is small, implying that they are practically unimportant. The Licensing Act has failed to reduce the burden of alcohol-related assaults presenting to our emergency department.
authors.affiliation: Cambridge University, Cambridge University Foundation Hospitals Trust, UK.
authors.forename: Ben H
authors.initials: BH
authors.lastname: Peirce
authors.forename: Adrian A
authors.initials: AA
authors.lastname: Boyle
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D004636:Emergency Service, Hospital / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data*; D005260:Female; D033161:Government Regulation; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D011640:Public Policy; D012189:Retrospective Studies; D013223:Statistics as Topic; D013997:Time Factors; D006113:United Kingdom; D014754:Violence / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data*; D055815:Young Adult