Metadata for AWISS Injury Indicator Analyses

Recent changes to the AWISS injury specifications used for Emergency Department attendances and Hospital Admissions are summarised in the following document: https://www.awiss.org.uk/wp-content/uploads/200914_Injury_Spec_change_EDDS_PEDW.docx

Meta Data for Injury Fatality Figures

Meta Data for Hospital Admissions

Meta Data for Emergency Department Attendances

Meta Data for Injury DALYs

Meta Data for Injury Fatality Figures

Data Source: The Office for National Statistics (ONS) mortality data were analysed in the All Wales Information Surveillance System (AWISS), within the Secure Anonymised Information Linkage (SAIL) Databank.

Inclusion criteria

  • Only individuals, living in Wales, with a valid Anoymised Information Linkage Field (ALF_E) in the SAIL Databank were included. ALF_E’s are a double encrypted version of an individuals NHS number.
  • Valid ‘date of death registration’ between 01/01/2010 – 31/12/2017
  • Only Welsh residents (inclusion in the Welsh Demographic Service Dataset (WDSD) dataset)
  • Valid gender code (1=Male, 2=Female)
  • Age <=110
  • ICD10 codes recorded in the underlying cause of deathfield in the ONS mortality dataset used to establish injury deaths. Injury ICD10 codes: S%%%, T00-T65, T704, T708, T709, T71, T750, T751, T754, T794, T795, T796, T797, T798, T799, V, W00-W41, W44-W77, W79-W99, X00-X29,  X32-X49, X59-X99, Y00-Y05, Y08-Y32, Y35-Y36, F100,  F110,  F120,  F130,  F140,  F150,  F160,  F170,  F180,  F190.

Indicator criteria

  • Injury categories: Road Traffic Injuries: V01-V06 (fourth character 1, 9), V09 (fourth character 2, 3, 9), V10-V18 (fourth character 4, 5, 9), V19 (fourth character 4, 5, 6, 8, 9), V20-V28 (fourth character 4, 5, 9), V29 (fourth character 4, 5, 6, 8, 9), V30-V38 (fourth character 5, 6, 7, 9), V39 (fourth character 4, 5, 6, 8, 9), V40-V48 (fourth character 5, 6, 7, 9), V49 (fourth character 4, 5, 6, 8, 9), V50-V58 (fourth character 5, 6, 7, 9), V59 (fourth character 4, 5, 6, 8, 9), V60-V68 (fourth character 5, 6, 7, 9), V69 (fourth character 4, 5, 6, 8, 9), V70-V78 (fourth character 5, 6, 7, 9), V79 (fourth character 4, 5, 6, 8, 9), V82 (fourth character 1, 2, 3, 6, 7, 8, 9), V83 (fourth character 0, 1, 2, 3),  V84 (fourth character 0, 1, 2, 3), V85 (fourth character 0, 1, 2, 3), V86 (fourth character 0, 1, 2, 3), V87 (fourth character 0, 1, 2, 3, 4, 5, 6, 7, 8, 9) V89 (fourth character 2, 3, 9).  Intentional self-harm: X60-X84
  • Age group categories: 0-4, 5-9, 10-14, 15-19, 20-24, 25-29, 30-34, 35-39, 40-44, 45-49, 50-54, 55-59, 60-64, 65-69, 70-74, 75-79, 80-84, 85+.   Age groups for road traffic fatalities: 17-24 years.  Age groups for self-harm related fatalities: 10-24 years
  • Area Level Deprivation: based on Lower Super Output Area(LSOA) of individuals address, and 2011 Welsh Index of Multiple Deprivation (WIMD) fifths: 1=Most deprived, 2, 3, 4, 5=Least deprived.
  • Local Authority and Health Board: based on LSOA code of the patients’ address

Population data source: Welsh Demographic Service Dataset (WDSD).  

The Welsh population was estimated using WDSD data and a reference date of 1st July every year between 2010 and 2017. The WDSD maintains a register of all Welsh residents’. Age was assigned based on the July reference date, and only includes those individuals recorded as having an age<=110. Only those individuals with a valid gender code in the WDSD dataset were included in our population estimates.

Data Presentation

  • Injury fatality rates presented as rate per 100,000 population
  • WHERE COUNTS WERE <5 FOR A GIVEN INDICATOR, RATES ARE PRESENTED AS NULL TO ADDRESS DISCLOSURE RISKS.

Meta Data for Hospital Admissions

To note the injury specification was changed in 2020. More details in the following report: https://www.awiss.org.uk/wp-content/uploads/201217_injury_spec_change.pdf 

Data Source: Patient Episode Database for Wales (PEDW) analysed in the All Wales Information Surveillance System (AWISS) within the Secure Anonymised Information Linkage (SAIL) Databank. The PEDW dataset contains all inpatient and day case activity undertaken in NHS Wales plus data on Welsh residents treated in English Trusts.

Inclusion criteria

  • Only individuals, living in Wales, with a valid Anoymised Information Linkage Field (ALF_E) in the SAIL Databank were included. ALF_E’s are a double encrypted version of an individuals NHS number.
  • Valid admission date between 01/01/2010 – 31/12/2017
  • Only Welsh residents (inclusion in the Welsh Demographic Service Dataset (WDSD))
  • Valid gender code (1=Male, 2=Female)
  • Age <=110
  • Only patients with the following admission method codes: 21-A&E or dental casualty department of the health care provider; 22– GP, after a request for immediate admission has been made direct to a hospital provider by a General Practitioner or deputy; 23-Bed Bureau; 24-Consultant clinic of this or another health care provider; 25-Domiciliary visit by Consultant; 27-Via NHS Direct Services; 28-Other means, including admitted from the ED department of another provider where they had not been admitted; 29-Emergency transfer.
  • Only cases where the 1st episode, in the 1st admission within a person super spell, contains the following ICD10 codes: S00-S99, T00-T65, T704, T708, T709, T71, T750, T751, T754, T794, T795, T796, T797, T798, T799, F100, F110, F120, F130, F140, F150, F160, F170, F180, F190
  • Specifically we followed the R/Z/V01-Y36 rule. A physical injury ICD10 code was required to either be in primary position in the first episode, or, if not in primary position, then only an R/Z/V01-Y36 ICD10 code or NULL values could precede the injury code.

Indicator criteria:

  • Injury categories: FALLS: W00-W15, W17-W19. ROAD TRAFFIC INJURIES: V01-V06 (fourth character 1, 9), V09 (fourth character 2, 3, 9), V10-V18 (fourth character 4, 5, 9), V19 (fourth character 4, 5, 6, 8, 9), V20-V28 (fourth character 4, 5, 9), V29 (fourth character 4, 5, 6, 8, 9), V30-V38 (fourth character 5, 6, 7, 9), V39 (fourth character 4, 5, 6, 8, 9), V40-V48 (fourth character 5, 6, 7, 9), V49 (fourth character 4, 5, 6, 8, 9), V50-V58 (fourth character 5, 6, 7, 9), V59 (fourth character 4, 5, 6, 8, 9), V60-V68 (fourth character 5, 6, 7, 9), V69 (fourth character 4, 5, 6, 8, 9), V70-V78 (fourth character 5, 6, 7, 9), V79 (fourth character 4, 5, 6, 8, 9), V82 (fourth character 1, 2, 3, 6, 7, 8, 9),  V83 (fourth character 0, 1, 2, 3),  V84 (fourth character 0, 1, 2, 3), V85 (fourth character 0, 1, 2, 3), V86 (fourth character 0, 1, 2, 3), V87 (fourth character 0, 1, 2, 3, 4, 5, 6, 7, 8, 9) V89 (fourth character 2, 3, 9). PEDESTRIAN and CYCLIST: V01 – V19. BURNS: T20-T32. SELF HARM: X60 – X84. ASSAULT: X85- Y05, Y08-Y09. HOME AND LEISURE: All injuries minus V01 – V99, X60 – X84, X85- Y05, Y08-Y09. POISONING: F100, F110, F120, F130, F140, F150, F160, F170, F180, F190, T36-T65.
  • Age group categories: 0-4, 5-9, 10-14, 15-19, 20-24, 25-29, 30-34, 35-39, 40-44, 45-49, 50-54, 55-59, 60-64, 65-69, 70-74, 75-79, 80-84, 85+. Falls: 65+ years. Road traffic injury: 17-24 years. Pedestrian and Cyclist: 0 – 16 years. Burns: 0-4 years. Self Harm: 10-24 years. Poisoning: 0 – 24 years.
  • Area Level Deprivation: based on Lower Super Output Area(LSOA) of individuals address, and 2011 Welsh Index of Multiple Deprivation (WIMD) fifths: 1=Most deprived, 2, 3, 4, 5=Least deprived.
  • Local Authority and Health Board: based on LSOA code of the patients’ address

Population data source: Welsh Demographic Service Dataset (WDSD)

The Welsh population was estimated using WDSD data and a reference date of 1st July every year between 2010 and 2017. The WDSD maintains a register of all Welsh residents’. Age was assigned based on the July reference date, and only includes those individuals recorded as having an age<=110. Only those individuals with a valid gender code in the WDSD dataset were included in our population estimates.

Data Presentation

  • Hospital admission rates presented as rate per 100,000 population. Population figures obtained from WDSD data.
  • WHERE COUNTS WERE <5 FOR A GIVEN INDICATOR, RATES ARE PRESENTED AS NULL TO ADDRESS DISCLOSURE RISKS.

Meta Data for Emergency Department Attendances

To note the injury specification was changed in 2020. More details in the following report: https://www.awiss.org.uk/wp-content/uploads/201217_injury_spec_change.pdf 

Data Source: Data in the Emergency Department Data Set (EDDS) were analysed in the All Wales Information Surveillance System (AWISS), within the Secure Anonymised Information Linkage (SAIL) Databank. The Emergency Department Data Set for Wales (EDDS) captures all activity at Accident and Emergency (A&E) departments and Minor Injury Units (MIU) in NHS Wales hospitals.

Inclusion criteria

  • Only individuals, living in Wales, with a valid Anoymised Information Linkage Field (ALF_E) in the SAIL Databank were included. ALF_E’s are a double encrypted version of an individuals NHS number.
  • Valid attendance date between 01/01/2010 – 31/12/2017
  • Only Welsh residents (inclusion in the Welsh Demographic Service Dataset (WDSD))*
  • Valid gender code (1=Male, 2=Female)*
  • Age <=110*

* Age, gender and LSOA information taken from both EDDS and WDSD (Welsh Demographic Service Dataset).  Where information differed between EDDS and WDSD, WDSD was used for age and gender, and EDDS for LSOA (as it was presumed address information would be more up to date in ED than in GP registrations).  Further where EDDS data was missing, WDS data was used populate where possible.

  • Only new attendances included (e.g. follow-up attendances excluded)

AND 

  • Injury ‘Attendance Group’ (11-15) and an injury related ‘Mechanism of Injury’ (1-12)
  • OR ‘Road Traffic Collision’ recorded in the ‘Activity at the Time of Injury’ field.
  • OR injury diagnosis code present in diagnosis positions 1-6 (EDDS codes or ICD10 codes as defined below) or treatment codes in positions 1-6 as defined below.

Diagnosis codes in positions 1-6:

01A – LACERATION

01B – CONTUSION

01C – ABRASION

01D – SOFT TISSUE INFLAMMATION

01Z – WOUND, OTHER OR UNSPECIFIED

02A – GLASGOW COMA SCORE 15

02B – GLASGOW COMA SCORE<15

02C – DENTAL INJURY

02Z – HEAD INJURY, OTHER OR UNSPECIFIED

03A – OPEN FRACTURE

03B – CLOSED FRACTURE

03C – FRACTURE DISLOCATION

03Z – FRACTURE, OTHER OR UNSPECIFIED

04A – SPRAIN

04B – DISLOCATION

04C – SUBLUXATION

04Z – JOINT INJURY, OTHER OR UNSPECIFIED

05Z – AMPUTATION, OTHER OR UNSPECIFIED

06A – MUSCLE INJURY

06B – TENDON INJURY

06C – NERVE INJURY

06D – VISCERAL INJURY

06E – VASCULAR INJURY

06Z – SOFT TISSUE INJURY, OTHER OR UNSPECIFIED

07A – ELECTRIC

07B – CHEMICAL

07C – RADIATION

07D – SCALD

07E – SUNBURN

07H – FROSTBITE

07Z – BURNS, SCALDS AND THERMAL CONDITIONS, OTHER OR UNSPECIFIED

08A – INGESTED FOREIGN BODY

08Z – FOREIGN BODY, OTHER OR UNSPECIFIED

09A – NEEDLE STICK INJURY

09B – HUMAN BITE

09C – ANIMAL BITE

09D – INSECT BITE OR STING

09Z – PUNCTURE WOUNDS, OTHER OR UNSPECIFIED

10A – ALCOHOL

10B – PRESCRIBED DRUG

10C – NON-PRESCRIBED/PURCHASED DRUG

10D – ILLICIT DRUG

10Z – POISONING OR OVERDOSE, OTHER OR UNSPECIFIED

11A – NEAR DROWNING

11Z – DROWNING, OTHER OR UNSPECIFIED

OR ICD10 codes: S00-S99, T00-T65, and T71, X49

Treatment codes in positions 1-6:

03Z – WOUND CLOSURE

04Z – REMOVAL FOREIGN BODY

06Z – MANIPULATION

Attendance category:

1 – NEW ATTENDANCE

01 – NEW ATTENDANCE

 

Indicator criteria

  • Injury categories: Poisonings: ICD10 codes T36-T65, X40-X49. Y10-Y19, X20-X29, X60-X69, X85-X90, EDDS codes 10A, 10B, 10C, 10D, 10Z or Mechanism of Injury = 1. Unintentional injuries in the home method 1: Attend group = 11 (accidental injuries) and location of injury in own home, others home or residential institution Unintentional injuries in the home method 2:  Attend group = 11 (accidental injuries) and activity at time of injury was not during work (1, 01), education (2, 02), sports (including during education) (3, 03) or road traffic collision (6, 06. Home and leisure method 1: Activity at time of injury = 3, 03, 4, 04, 5, 05, 7, 07 (sport, leisure or play, home, DIY, gardening activities, being taking care of) Home and Leisure method 2: Attend group not equal to 12 (assault), attend group not equal to 13 (self-harm) and injury was not a road traffic collision (activity at time of injury was not equal to 6, 06). Road traffic injuries:  Activity at time of injury =6 or 06 (road traffic collision)
  • Age group categories: 0-4, 5-9, 10-14, 15-19, 20-24, 25-29, 30-34, 35-39, 40-44, 45-49, 50-54, 55-59, 60-64, 65-69, 70-74, 75-79, 80-84, 85+. Unintentional injuries in the home: 0 – 7. Poisoning: 0-24 years.
  • Area Level Deprivation: based on Lower Super Output Area(LSOA) of individuals address, and 2011 Welsh Index of Multiple Deprivation (WIMD) fifths: 1=Most deprived, 2, 3, 4, 5=Least deprived.
  • Local Authority and Health Board: based on LSOA code of the patients’ address

Population data source: Welsh Demographic Service Dataset (WDSD)

The Welsh population was estimated using WDSD data and a reference date of 1st July every year between 2010 and 2017. The WDSD maintains a register of all Welsh residents’. Age was assigned based on the July reference date, and only includes those individuals recorded as having an age<=110. Only those individuals with a valid gender code in the WDSD data were included in our population estimates.

Data Presentation

  • Emergency department attendance rates presented as rate per 100,000 population. Population figures obtained from WDSD data.
  • WHERE COUNTS WERE <5 FOR A GIVEN INDICATOR, RATES ARE PRESENTED AS NULL TO ADDRESS DISCLOSURE RISKS.

Meta Data for Injury DALYs

Summary

DALYs are an important summary measure to estimate the the burden of  disease/injury and combine years of life lost (YLL) and years lived with disability (YLD). One DALY can be thought of as one lost year of “healthy” life.

A key component of DALY calculations are disability weights (DWs) which reflect the severity of an injury. Several studies have produced DW estimates for injuries, with one of the most comprehensive DW studies to date the Injury-VIBES (Validating and Improving Injury Burden Estimates Study). For the AWISS DALY estimates, we have used the Injury-VIBES DWs.   It should be noted that DALY calculations are continually being refined and improved, and thus new estimates produced each year are likely to change slightly.

Data Source and Methodology

A report produced for a separate project, InfAct (Information for Action!), summarises the DALY calculations and data sources used to produce our AWISS DALY estimates, and can be accessed by clicking on the following link: https://www.awiss.org.uk/wp-content/uploads/200327InFact_WP9_DALY_Case_Study.docx.  The report also discusses the strength and limitations of the AWISS DALY estimates. 

To facilitate AWISS DALY calculations, DWs were required to be matched to both hospitalised and non-hospitalised injuries in Wales. DWs reflect the severity of an injury, ranging from 0 (perfect health) to 1 (equivalent to death).  Please click on the links below to view the specific DWs matched to each injury:

Data Presentation

  • Injury related DALY estimates presented per year.
  • WHERE COUNTS WERE <5 FOR A GIVEN INDICATOR, DALYs ARE PRESENTED AS NULL TO ADDRESS DISCLOSURE RISKS.