Angharad Walters

The use of secure anonymised data linkage to determine changes in healthcare utilisation following severe open tibial fractures

Severe open fractures of the lower limbs are complex injuries requiring expert multidisciplinary management in appropriate orthoplastic centres. This study aimed to assess the impact of open fractures on healthcare utilisation and test the null hypotheses that there is no difference in healthcare utilisation between the year before and year after injury, and that there is no difference in healthcare utilisation in the year post-injury between patients admitted directly to an orthoplastic centre in keeping with the joint BOA/BAPRAS standards and those having initial surgery elsewhere. This retrospective cohort study utilising secure anonymised information linkage (SAIL), a novel databank of anonymised nationally pooled health records, recruited patients over 18 years of age sustaining severe open lower limb fractures managed primarily or secondarily at our centre and who had data available in the SAIL databank. 101 patients met inclusion criteria and 90 of these had records in the SAIL databank. The number of days in hospital, number of primary care attendances, number of outpatient attendances and number of emergency department attendances in the years prior and subsequent to injury were recorded. Patients sustaining open fractures had significantly different healthcare utilisation in the year after injury when compared with the year before, in terms of days spent in hospital (23.42 vs. 1.70, p=0.000), outpatient attendances (11.98 vs. 1.05, p=0.000), primary care attendances (29.48 vs. 11.99, p=0.000) and emergency department presentations (0.2 vs. 0.01, p=0.025). Patients admitted directly to orthoplastic centres had significantly fewer operations (1.78 vs. 3.31) and GP attendances (23.6 vs. 33.52) than those transferred in subsequent to initial management in other units. There is a significant increase in healthcare utilisation after open tibial fracture. Adherence to national standards minimises the impact of this on both patients and health services.

All Wales Injury Surveillance System revised: development of a population-based system to evaluate single-level and multilevel interventions

Background Injury surveillance has been established since the 1990s, but is still largely based upon single-source data from sentinel sites. The growth of electronic health records and developments in privacy protecting linkage technologies provide an opportunity for more sophisticated surveillance systems. Objective To describe the evolution of an injury surveillance system to support the evaluation of interventions, both simple and complex in terms of organisation. Methods The paper describes the evolution of the system from one that relied upon data only from emergency departments to one that include multisource data and are now embedded in a total population privacy protecting data linkage system. Injury incidence estimates are compared by source and data linkage used to aid understanding of data quality issues. Examples of applications, challenges and solutions are described. Results The age profile and estimated incidence of injuries recorded in general practice, emergency departments and hospital admissions differ considerably. Data linkage has enabled the evaluation of complex interventions and measurement of longer-term impact of a wide range of exposures. Conclusions Embedding injury surveillance within privacy protecting data linkage environment can transform the utility of a traditional single-source surveillance system to a multisource system. It also facilitates greater involvement in the evaluation of simple and complex healthcare and non-healthcare interventions and contributes to the growing evidence basis underlying the science of injury prevention and control.

493 Cohort study of osteoporosis and fracture risk: are we achieving benefit with secondary prevention?

Background Osteoporosis is a global disease with a 30–40% lifetime risk of associated fractures according to the World Health Organisation. Osteoporosis incidence is likely to rise with ageing populations. Risk factor modification and medical treatments may reduce fracture risk. This work aimed to investigate the time to second fracture of patients receiving medical secondary prevention following index fracture compared to those that did not. Methods An observational study design involved the formation of an anonymised e-cohort utilising linked records. All low impact fractures in patients aged >60 years were identified from the Secure Anonymised Information Linkage database between 01/04/2009 and 31/12/2014. Index and secondary fractures were identified from the emergency department and inpatient data sets. Linkages were made to censor for migration and mortality. Linked primary care records identified patients that had received prescriptions for fracture prevention medications. Statistical analysis involved regression models with accelerated time adjustments. Results Over 49,000 cases were included. Of these, 8,033 (16.1%) had received medical treatment, the median age was 78 years (range 60–108) and 14,120 (28.4%) were male. Receiving medical treatment was significantly associated with increasing age (OR 1.02, 95% CI: 1.017–1.022, p < 0.001) and female gender (p < 0.001). Secondary prevention was significantly and independently associated with lower hazard of second fracture (HR 0.25, 95% CI: 0.15–0.41, p < 0.001). Conclusions Secondary medical prevention was associated with a 75% reduction in the hazard of sustaining a second fracture. However, fewer than a fifth of patients received such treatment. Study limitations include selection bias and potential residual confounding as patients were not randomised. Future work should focus on groups most likely to benefit from secondary prevention treatment to better inform clinical practice.

417 Incidence and epidemiology of burns treated in the welsh centre for burns

Background It is important to understand the epidemiology of burns in order to support the development and refinement of preventative measures. We used population based data from the Welsh Centre for Burns and Plastic Surgery (catchment area 2.3 million people) to study trends in the epidemiology of burns. Methods Anonymised data from the Welsh Burns Centre have been included in the Secure Anonymised Information Linkage (SAIL) databank and linked to a population register. To describe the epidemiology of burns treated at the centre, data were restricted to acute injury assessments/admissions between 01/01/2003 and 31/12/2012 for patients who lived in Wales. Results During the 10 years, there were 7160 acute injury admissions/assessments. There is an increasing trend in the rates over the decade, increasing from 26.6 per 100,000 population in 2003 to 31.9 in 2012. Rates of burns in the home have increased from 13.2 per 100 K in 2003 to 20.8 in 2012 and more specifically, rates of burns in the kitchen have increased. During 2012, rates of treated burns were highest in males aged 0–4. The 0–4 age group suffer mainly from scalds followed by contact burns; contact burn rates have doubled over the ten years for this group of patients. Over the decade, rates were highest in the most deprived quintiles; however the rates are increasing in the least deprived and a substantial narrowing of the inequality can be seen over time. The distance travelled to Morriston hospital does not appear to be increasing over time and the severity of the burns have not changed over the decade; therefore the increase in the rate of treated burns does not appear to be due to an increasing rate of transfers of more serious burns from other hospitals in Wales. Conclusions Given increasing incidence and narrowing of inequalities more effective preventive interventions are needed.