A&E Attendances and Hospital Admissions Among Children and Young People

This topic area covers statistics and information relating to A&E attendances and hospital admissions among children and young people including local strategic need and service provision. Further information relating to hospital admissions as a result of unintentional and deliberate injuries can be found within Accidents and Injuries Among Children and Young People under Health Factors under Children and Young People. Information on hospital admissions for specific diseases and medical conditions among adults can be found on the specific pages for that disease or medical condition within Health Factors under Adults.

This page contains information from the Office for Health Improvement & Disparities’ Fingertips. Information is taken ‘live’ from the site so uses the latest available data from Fingertips and displays it on this page. As a result, some comments on this page may relate to an earlier period of time until this page is next updated (see review dates at the end of this page).

Headlines

• A&E attendances among infants and children aged 0-4 years have dramatically increased in Hull in the last 2-3 years. In 2019/20, there were 18,090 A&E attendances compared to 11,091 in 2016/17, with more gradual increases prior to that (7,807 attendances in 2010/11). The rate of A&E attendance in Hull in 2019/20 is more than twice as high as it was in 2010/11.
• From local A&E admission data, it appears that A&E attendances among under fives approximately halved during 2020/21 due to the COVID-19 pandemic, but it appears that the attendances during 2021/22 are as high as they were in 2019/20.
• Whilst the emergency hospital admission rate among infants and children aged 0-4 years in Hull is higher than England, the rate has not changed significantly over time, and admissions among babies aged under 14 days is lower in Hull compared to England. Admissions for lower respiratory tract infections among those aged under one year and admissions for gastroenteritis among 2-4 year olds are both higher in Hull compared to England.
• Given that A&E attendance has increased so markedly among those under five years of age, it is perhaps not surprising that this has occurred among under 18s too. The rate of A&E attendance was slightly lower in Hull than England in 2011/12, but increased gradually from 346 to 478 attendances per 1,000 population in 2016/17. However, the rate increased to 694 per 1,000 population in 2019/20 (67% higher than England) with 39,795 A&E attendances in total.
• For 2019/20, attendances among children aged under five years accounted for 45% of under 18s attendances.
• The emergency hospital admission rate among under 18s remained statistically significantly higher than England until 2019/20 with 4,875 admissions in total that year. In 2020/21 emergency admissions decreased significantly in Hull, as in England, due to the COVID-19 pandemic, as attendances at hospital decreased sharply.
• Hospital admissions among under 19s for epilepsy are considerably higher in Hull compared to England for most years, as are admissions caused by unintentional and deliberate injuries among 0-14s (although similar to England in 2020/21), alcohol-specific admissions among under 18s (particularly for males), and admissions due to substance abuse. In contrast, admissions for asthma, diabetes, self-harm, and mental health, and admissions caused by unintentional and deliberate injuries among 15-24s are lower in Hull compared to England as are admissions for gastroenteritis among children under one year of age and lower respiratory tract infections among children aged 2-4 years.

The Population Affected – Why Is It Important?

Hospitals and the NHS are currently under extreme stress and pressure in terms of increased numbers of people attending A&E and being admitted to hospital. This has always been the case during winter months, but increasingly this pressure is arising throughout the entire year, and this has increased dramatically with the COVID pandemic.

Thus, whilst it is important that people seek medical help early in an emergency or where there is serious medical need, it is also important that people do not attend A&E when a more appropriate service should have been accessed instead. Such attendances will potentially mean that treatment is delayed for those most in need of urgent medical help.

Furthermore, attendances at A&E and admissions to hospital, particularly emergency hospital admissions which are the most expensive for the NHS can be minimised through prevention such as reducing exposure to second-hand smoke, accident prevention, improved road safety, and access to other early help community services such as pharmacies and urgent treatment centres.

The rates of A&E attendance and hospital admissions are given on The Office for Health Improvement & Disparities’ Fingertips, and the information is presented for different age groups, and for different types of causes of admission and different medical conditions. Hospital admission rates are given for asthma, diabetes, epilepsy, unintentional and deliberate injuries, self-harm and mental health, and admissions due to alcohol and substance abuse. For children aged under five years, admission rates are also given for gastroenteritis and lower respiratory tract infections.

Note that most of the rates presented below are described as rates of hospital admissions with the exception of those relating to alcohol which are stated as rates of hospital episodes. Each hospital admission, hospital stay or hospital ‘spell’ is made up of one or more hospital episodes. Each hospital episode relates to a period of care for a patient under a single consultant within one hospital provider. Thus if a patient moves from one consultant to another (for example, if they move from one speciality to another), or if a patient is transferred to another hospital (for example, if they require specialist care) then there will be more than one hospital episode for that hospital stay. In most cases, a hospital stay has a single hospital episode, but for a small number of hospital stays there can be a relatively large number of hospital episodes. However, in relation to hospital admission data presented on The Office for Health Improvement & Disparities’ Fingertips for children and young people, only those relating to alcohol mention hospital episodes and despite this, the information presented appears to be hospital admissions rather than hospital episodes based on information presented in their definitions section.

The number of hospital admissions are generally rounded to the nearest five. In most cases, the rates of A&E attendance and hospital admission are given as a crude rate, but the hospital admission rates for alcohol-specific conditions and substance misuse are given as directly standardised rates (adjusted to take into consideration the age distribution of the local population).

Note also that the rate of A&E attendances and hospital admission are influenced by local variation in referral and admission practices as well as variation in incidence or prevalence.

The Hull Picture

A&E Attendances Among Under Fives

A&E attendances among those aged under one year and 0-4 years in Hull are considerably higher in Hull compared to England (44% and 62% higher than England respectively for 2019/20). The number of A&E attendances are given as a rate per 1,000 population.

The A&E attendance rate in Hull was comparable to England in 2016/17, but has since increased markedly for both infants under one year and those aged 0-4 years. In 2019 there were 3,175 live birth and in 2020 there were 3,123 live births in Hull, while during 2019/20 there were more than 4,660 attendances at A&E for infants under one year of age. This means that significant numbers are attending more than once as it assumed that many will not need to attend at all. The Office for National Statistics estimate there are 16,575 children aged 0-4 years living in Hull as at mid-year 2020, and with 18,090 attendances at A&E for children aged 0-4 years in Hull during 2019/20, this also means that significant numbers are attending more than once as it is likely that a high proportion of children will not attend at all in the year.

Thus in 2019/20, 26% of A&E attendances among children aged under five years were among infants under one year of age which is more than expected if the rate of hospital admissions were evenly spread (20%) across the five single years of age from zero to four years.

M0re recent local data is available for patients registered with Hull GPs. The number of patients registered with Hull GPs was around 306,000 in early 2022 which is higher than the resident population of Hull (see Population Estimates under Population for more information). During 2020/21, there were 8,823 A&E attendances for children aged 0-4 years in Hull which is almost half of the number of attendances for 2019/2o due to the COVID-19 pandemic. For the first three quarters of 2021/22, there have been 14,347 A&E attendances among under fives, so it appears that the numbers have returned to similar levels to that observed for 2019/20.

Among infants under one year, there were 2,544 A&E attendances during 2020/21 and there has been 3,678 A&E attendances in the first three quarters of 2021/22.

There are more attendances among boys compared to girls with 56% of the A&E attendances among under fives occurring among boys for 2020/21, and 55% for the first three quarters of 2021/22.

The highest number of A&E attendances occur for respiratory conditions (1,126 for 2020/21 and 3,317 for the first three quarters of 2021/22), although a high number of attendances find that there is nothing abnormal detected (1,126 for 2020/21 and 1,503 for the first three quarters of 2021/22) or where the diagnosis was not classifiable (280 for 2020/21 and 756 for the first three quarters of 2021/22). The number of head injuries was also relatively high (705 for 2020/21 and 535 for the first three quarters of 2021/22) as well as attendances for ear, nose and throat conditions (274 for 2020/21 and 807 for the first three quarters of 2021/22) and gastrointestinal conditions (497 for 2020/21 and 756 for the first three quarters of 2021/22).

Hospital Admissions Among Under Fives

Hospital Admissions Among Babies Under 14 Days

The rate of hospital admissions for babies aged under 14 days (per 1,000 population) in Hull are almost half that of England for 2020/21.

The hospital admission rate for babies under 14 days has also been significantly lower than England each year since 2014/15.

Emergency Hospital Admissions Among All Under Fives

The rate of emergency hospital admissions among children under five years of age is significantly lower in Hull compared to England for 2020/21.

However, until 2019/20, emergency hospital admissions among children aged 0-4 years had consistently been significantly higher in Hull compared to England with over 3,000 admissions in Hull per year. Until 2020/21, the rate had not changed much over time, although there had been reductions since 2011/12 and 2012/13, but there is year-on-year variability. The large reduction seen in 2020/21 is due to the COVID-19 pandemic when the numbers of people attending hospital fell significantly across the country.

Hospital Admissions for Gastroenteritis

For 2020/21, hospital admissions for gastroenteritis in infants under one year of age are lower in Hull compared to England, similar for those aged one year, but higher among those aged 2-4 years. Rates are given as hospital admissions per 10,000 population. The number of admissions are relatively low, and in 2020/21, the rates are not given for all local authorities across the region due to small numbers.

The rates in Hull have generally been higher than England. However, the number of hospital admissions are relatively low and there is year-on-year variability in the number of admissions for gastroenteritis in Hull (see Small Numbers for more information). Furthermore, it is possible that there could be multiple hospital admissions from the same children in a single financial year.

In 2019/20, there were around 145 hospital admissions but for 2020/21 this decreased to around 50 hospital admissions (numbers on The Office for Health Improvement & Disparities’ Fingertips have been rounded to the nearest five hospital admissions for each age group).

Prior to 2020/21, the highest number of hospital admissions occurred for infants under one year of age, and children aged one year old both with generally around 40-60 hospital admissions per year for each age group. There were fewer admissions among children aged 2-4 years (on average around 10-30 hospital admissions per year for each single year of age).

Hospital Admissions for Lower Respiratory Tract Infections

In 2020/21, hospital admissions for lower respiratory tract infections in infants under one year are higher in Hull compared to England (142 versus 95 admissions per 1,000 population), but the rate in Hull was similar to England among children aged one year of age. There were few hospital admissions for lower respiratory tract infections among children aged 2-4 years in Hull (and many other local authorities across the region) during 2020/21 and the rates are not given on Fingertips.

These trends have generally persisted over the last seven years with rates higher in Hull compared to England among infants under one year, but lower among children aged 1-4 years.

The numbers of hospital admissions were relatively low though particularly for children aged 1-4 years potentially resulting in year-on-year variability (see Small Numbers for more information). Furthermore, it is possible that there could be multiple hospital admissions from the same children in the same financial year.

During 2019/20, there were 280 hospital admissions for lower respiratory tract infections among infants aged under one year with numbers relatively small among children aged one year (30 admissions) and 2-4 years (15 admissions). The number of admissions decreased considerably in 2020/21 to 45 hospital admissions among those aged under one year and 10 hospital admissions among children one year of age, although the admission rate remained relatively unchanged among children aged 2-4 years (numbers rounded to nearest five on Fingertips).

Hospital Admissions for Accidents and Injuries

Emergency hospital admissions among those aged 0-4 years caused by unintentional and deliberate injuries are marginally lower in Hull compared to England in 2020/21. Rates are given as emergency hospital admissions per 10,000 population.

The emergency hospital admission rate for injuries among 0-4s has been decreasing in Hull, and at a faster rate than reductions in England and across Yorkshire and Humber, thus the inequalities gap between Hull and England has reduced in recent years.

The hospital admission rate in 2020/21 is the lowest it has been in Hull and it is the first time the rate in Hull has been lower than England (since 2010/11), although it is likely that the rate in 2020/21 is influenced by the pandemic.

Further information is available on the type of injury from The Office for Health Improvement & Disparities’ Fingertips for those aged 0-4 years, and is presented within Accidents and Injuries Among Children and Young People under Health Factors under Children and Young People.

Hospital Admissions Among Children Aged 0-9 Years

Hospital Admissions for Asthma, Epilepsy and Diabetes

For 2020/21, hospital admissions among children aged 0-9 years were lower in Hull compared to England for asthma, slightly higher for diabetes and slightly lower for epilepsy. The rate is given as the number of hospital admissions per 100,000 population aged 0-9 years.

The number of hospital admissions are given on Fingertips, but are rounded to the nearest five admissions. The numbers of hospital admissions were relatively low though (particularly for diabetes) potentially resulting in year-on-year variability (see Small Numbers for more information). Furthermore, it is possible that there could be multiple hospital admissions from the same children within the same financial year.

For 2020/21, there were 15 hospital admissions for asthma, ten hospital admissions for diabetes and 25 hospital admissions for epilepsy among children aged 0-9 years in Hull.

The rate of hospital admissions for asthma over the last seven years has shown a marked decrease in Hull. Furthermore, the rate has decreased at a faster rate than England over the same time period which has reduced the inequalities gap to the extent that the rate in Hull is now lower than that of England. The hospital admission rate in Hull for 2010/11 was 50% higher than England, but in 2020/21 the rate in Hull is half that of England’s rate.

The rate of hospital admissions for diabetes has remained relatively constant over the last seven years, although there has been some year-on-year variability.

The hospital admission rate for epilepsy has reduced considerably in Hull over the last seven years to 2020/21. The rate in Hull during 2010/11 and 2011/12 was around three times higher than the hospital admission rate in England. However, for the last three years, the rate has been similar to England and for 2020/21 the rate is slightly lower than England.

Hospital Admissions Among Children Aged 10-18 Years

Hospital Admissions for Asthma, Epilepsy and Diabetes

Compared to England, young people aged 10-18 years living in Hull had fewer hospital admissions for asthma and diabetes, but considerably more hospital admissions for epilepsy for 2020/21. Rates are given as the number of hospital admissions per 100,000 population, and the rates are not given for some local authorities for 2020/21 for asthma due to small numbers.

There is some year-on-year variability for the hospital admission rate for asthma among young people aged 10-18 years although the levels in Hull have been similar to or lower than England, and relatively unchanged over the period 2010/11 to 2019/20, before dropping sharply in 2020/21 due to the reduced number of hospital admissions during the COVID-19 pandemic.

The hospital admission rate for diabetes in Hull has generally been similar to England, although significantly higher for 2011/12, 2012/13 and 2018/19. As mentioned above, it is possible with so few hospital admissions per year that a small number of individuals could have a considerable influence on the rate if they have multiple hospital admissions during the same financial year or even different years.

In 2014/15 there was a particularly high rate of hospital admission for epilepsy in Hull. It is possible that this could have been multiple hospital admissions from the same children. With the exception of 2014/15, the admission rate in Hull for epilepsy among those aged 10-18 years has been between 75 and 145 hospital admissions per 100,000 population compared to a rate of 50-60 hospital admissions per 100,000 population for England.

The hospital admission rate in Hull has been statistically significantly higher than England for all years except 2016/17 and 2017/18. The rate in Hull has increased the next two years to 2019/20, and the rate in 2019/20 was the highest it had been since 2014/15. The rate did fall between 2019/20 and 2020/21, but this could be associated with the COVID-19 pandemic (although the rate only decreased slightly in England or across the region between 2019/20 and 2020/21). Despite the recent fall, the rate in Hull for 2020/21, it remains 50% higher than England.

A&E Attendances and Hospital Admissions for All Children and Young People

A&E Attendances

The number of attendances at A&E among those aged under 18 years is considerably higher in Hull compared to England, and in 2019/20 were the highest across Yorkshire and Humber by some margin. Rates are given as admissions per 1,000 population.

In 2019/20, there were 39,795 A&E attendances among children and young people aged under 18 years in Hull. The Office for National Statistics estimated that the total resident population of Hull aged under 18 years in 2019 was 57,370. Thus with 39,795 A&E attendances, this equates to an average of 0.69 A&E attendances per child, although not all children will have attended but others will have attended A&E more than once during the year.

The number of A&E attendances per 1,000 children and young people in Hull aged under 18 years has consistently been higher than England, and statistically significantly so (for all except 2011/12).

Whilst there has been an increase over the entire period from 2011/12 to 2019/20, the increases were most dramatic in 2017/18 and 2018/19.

In 2011/12, there were 346 A&E attendances per 1,000 children in Hull, but this had gradually increased to 478 A&E attendances per 1,000 children by 2016/17. Between 2016/17 and 2017/18, the rate increased by almost one-third (32%) to 629 A&E attendances per 1,000 children, and between 2017/18 and 2018/19 the rate increased further by 10% to 689 with a small increase in 2019/20 to 694 A&E attendances per 1,000 children. Thus, overall, between 2011/12 and 2019/20, the rate of A&E attendances per 1,000 children has doubled (increased by 101%). There has also been an increase across England and the Yorkshire and Humber region, but the increases have been much smaller (at 14% and 11% respectively).

As noted earlier, there were 18,090 A&E attendances among children aged 0-4 years including 4,665 among infants under one year. Thus, these make up 45% and 12% of A&E attendances respectively. These percentages were similar in 2017/18 and 2018/19, but have increased from earlier years (2011/12) when infants aged under one year and children aged under five years made up around 10% and 40% of A&E attendances respectively.

All Emergency Hospital Admissions

Emergency hospital admissions among those aged under 18 years are lower in Hull compared to England for 2020/21. Rates are given as emergency hospital admissions per 1,000 population.