Journal of the Royal Society of Medicine

To examine trends in road death rates for child pedestrians, cyclists and car occupants.

Analysis of road traffic injury death rates per 100 000 children and death rates per 10 million passenger miles travelled.

England and Wales between 1985 and 2003.

Children aged 0–14 years.

None.

Death rates per 100 000 children and per 10 million child passenger miles for pedestrians, cyclists and car occupants.

Death rates per head of population have declined for child pedestrians, cyclists and car occupants but pedestrian death rates remain higher (0.55 deaths/100 000 children; 95% confidence interval [CI] 0.42 to 0.72 deaths) than those for car occupants (0.34 deaths; 95% CI 0.23 to 0.48 deaths) and cyclists (0.16 deaths; 95% CI 0.09 to 0.27 deaths). Since 1985, the average distance children travelled as a car occupant has increased by 70%; the average distance walked has declined by 19%; and the average distance cycled has declined by 58%. Taking into account distance travelled, there are about 50 times more child cyclist deaths (0.55 deaths/10 million passenger miles; 0.32 to 0.89) and nearly 30 times more child pedestrian deaths (0.27 deaths; 0.20 to 0.35) than there are deaths to child car occupants (0.01 deaths; 0.007 to 0.014). In 2003, children from families without access to a vehicle walked twice the distance walked by children in families with access to two or more vehicles.

More needs to be done to reduce the traffic injury death rates for child pedestrians and cyclists. This might encourage more walking and cycling and also has the potential to reduce social class gradients in injury mortality.

To use routine data to identify patients at high risk of future emergency hospital admissions.

Descriptive analysis of inpatient hospital episode statistics. Predictive model developed using multiple logistic regression.

National Health Service hospital trusts in England.

All patients with an emergency admission to an NHS hospital between 1 April 2000 and 31 March 2001.

‘High-impact users’ were defined as patients who had at least one emergency inpatient admission and who then went on to have at least two further emergency hospital admissions in the 12 months following the start date of that index admission.

2 895 234 patients were admitted as emergencies in 2000/2001, of whom 147 725 (5.1%) did not survive their first spell. Of the 2 747 509 surviving patients, 269 686 (9.8%) subsequently had at least two or more emergency admissions within 365 days of the index date of admission. A further 236 779 (8.6%) died during this period. Risk factors for becoming a high-impact user included the number of emergencies in the 36 months before index spell, comorbidity, age, an admission for an ambulatory care sensitive condition, ethnicity, area-level socio-economic data, local admission rates, the number of episodes in the index spell, sex and the source of admission. The predictive model based on all emergency admissions produced a receiver operating characteristic curve score of 0.72.

Routine hospital episode statistics can be used to identify patients who are at high risk of suffering future multiple emergency hospital admissions. The potential cost savings in preventing a proportion of these subsequent admissions need to be compared with the costs of case management of these patients.