Trends in admission and death rates due to paediatric head injury in England, 2000-2011.
BACKGROUND
The number of children admitted to hospital is increasing year on year, with very short-stay admissions doubling in the last decade. Childhood head injury accounts for half a million emergency department attendances in the UK every year. The National Institute for Health and Care Excellence (NICE) has issued three iterations of evidence-based national guidance for head injury since 2003.


OBJECTIVE
To assess if any changes in the rates of admission, death or causes of head injury could be temporally associated with the introduction of sequential national guidelines by longitudinal analysis of the epidemiology of paediatric head injury admissions in England from 2000 to 2011.


METHODS
Retrospective analysis of English Hospital Episode Statistics data of children under the age of 16 years old admitted to hospital with the discharge diagnosis of head injury.


RESULTS
The number of hospital admissions with paediatric head injury in England rose by 10% from 34 150 in 2000 to 37 430 in 2011, with the proportion admitted for less than 1 day rising from 38% to 57%. The main cause of head injury was falls (42-47%). Deaths due to head injury decreased by 52% from 76 in 2000 to 40 in 2011. Road traffic accidents were the main cause of death in the year 2000 (67%) but fell to 40% by 2011. In 2000, children who were admitted or died from head injuries were more than twice as likely to come from the most deprived homes compared with least deprived homes. By 2011, the disparity for risk of admission had narrowed, but no change was seen for risk of death.


CONCLUSIONS
Temporal relationships exist between implementation of NICE head injury guidance and increased admissions, shorter hospital stay and reduced mortality. The underlying cause of this association is likely to be multifactorial.
Bristol Royal Hospital for Children, University Hospitals Bristol NHS Foundation Trust, Bristol, UK School of Clinical Sciences, University of Bristol, UK.
Robin
R
Marlow
Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK.
Julie
J
Mytton
Emergency Department, St Mary's Hospital, Imperial College NHS Healthcare Trust, London, UK.
Ian K
IK
Maconochie
Research and Innovation, University Hospitals Bristol NHS Foundation Trust, Bristol, UK.
Hazel
H
Taylor
Bristol Royal Hospital for Children, University Hospitals Bristol NHS Foundation Trust, Bristol, UK Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK.
Mark D
http://orcid.org/0000-0002-8634-7210
MD
Lyttle
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D006259:Craniocerebral Trauma / Q000401:mortality*; D004636:Emergency Service, Hospital; D004739:England / Q000453:epidemiology; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007902:Length of Stay; D008297:Male; D010343:Patient Admission / Q000639:trends*; D012189:Retrospective Studies
Accident & Emergency; Epidemiology; Injury Prevention