Social deprivation and adult head injury: a national study

Abstract

Objectives: To establish the association between measures of social deprivation, mechanisms of injury, patterns of care, and outcome following closed head injury. Methods: All Scottish adult A&E attendees with closed head injury (AIS Head >3) between July 1996 and December 2000 were studied. Results: Trauma was more common in individuals from more deprived areas. Within the trauma population head injury was relatively more common in patients from deprived areas; these individuals were more likely to sustain an isolated head injury as a result of an assault. Admission GCS was higher and normal physiology (as assessed by the RTS) was more common in individuals from more deprived areas. Recorded co-morbidity was similar between the two groups with the exception of a history of alcohol or substance abuse which was more common among patients from more deprived areas. Similar proportions of patients from more deprived and less deprived areas were transferred to the Regional Neurosurgical Centre. For patients who were transferred directly from A&E, time to neurosurgical theatre was similar for both groups. Length of hospital and ITU stay was less in patients from more deprived areas. After adjusting for known predictors of outcome using logistic regression analysis, there was no significant difference in mortality between patients from more deprived and less deprived areas. Conclusions: Residing in a more deprived area is not associated with increased mortality from head injury among adults in Scotland. It is associated with different patterns of injury and a different process of care following presentation to hospital.

Social deprivation and adult blunt chest trauma: A retrospective study

“…This finding supports Dunn et al who reported that head injured patients in the 'more deprived' group were more likely to sustain their injury as a result of assault. 6 They also reported that the patients in the less-deprived group were more likely to be in a road traffic accident or to have fallen from a height; however, the results of this study found no significant difference in any other injury mechanism. This may be due to the different injured body part under investigation.…”

“…This result does not support the results of Dunn et al who reported that headinjured trauma patients from a more deprived area had shorter median length of stay than the headinjured patients from a less-deprived area; however, this may again reflect the difference in body part injured. 6 It could be suggested that the increased incidence of prolonged length in the 'more deprived' group of patients is due to a number of factors including higher rates of alcoholism and smoking, but further research in this area would be needed to draw firm conclusions. As a result of the risk of prolonged length of stay in the more deprived isolated blunt chest wall trauma patient, the clinician managing the patient should consider the patient's social status when planning for hospital discharge.…”

“…[2][3][4] Research has also highlighted that social deprivation can affect patterns of injury and outcome after trauma. 5,6 There is a strong relationship between social deprivation and the incidence of injury, and evidence suggests that the disadvantaged are less likely to survive. [2][3][4][5][6] Higher crime rates and alcoholism associated with deprived areas may result in increased incidence of trauma.…”

“…5,6 There is a strong relationship between social deprivation and the incidence of injury, and evidence suggests that the disadvantaged are less likely to survive. [2][3][4][5][6] Higher crime rates and alcoholism associated with deprived areas may result in increased incidence of trauma. Previous research has suggested that deprivation may be a risk factor for poorer outcomes due to the association with smoking, extremes of body mass index or diabetes, financial hardship and homelessness.…”

The Epidemiology of Fractures Caused by Falls Down Stairs

“…The Carstairs score is a -score based on overcrowding, male unemployment, social class, and car ownership. It has been extensively used to examine social deprivation in orthopaedic surgery [7,8,12] and other branches of medicine [9,13]. The Carstairs score can be used to divide the population of Scotland into five equal quintiles, with Quintile 1 (Q1) being the most affluent and Quintile 5 (Q5) being the most deprived.…”