Maltreatment or violence-related injury in children and adolescents admitted to the NHS: comparison of trends in England and Scotland between 2005 and 2011

OBJECTIVE: Legislation to safeguard children from maltreatment by carers or violence by others was advanced in England and Scotland around 2004–2005 and resulted in different policies and services. We examined whether subsequent trends in injury admissions to hospital related to maltreatment or violence varied between the two countries. SETTING AND PARTICIPANTS: We analysed rates of all unplanned injury admission to National Health Service (NHS) hospitals in England and Scotland between 2005 and 2011 for children and adolescents aged less than 19 years. OUTCOMES: We compared incidence trends for maltreatment or violence-related (MVR) injury and adjusted rate differences between 2005 and 2011 using Poisson or negative binomial regression models to adjust for seasonal effects and secular trends in non-MVR injury. Infants, children 1–10 years and adolescents 11–18 years were analysed separately. RESULTS: In 2005, MVR rates were similar in England and Scotland for infants and 1–10-year-olds, but almost twice as high in Scotland for 11–18-year-olds. MVR rates for infants increased by similar amounts in both countries, in line with rising non-MVR rates in England but contrary to declines in Scotland. Among 1–10-year-olds, MVR rates increased in England and declined in Scotland, in line with increasing non-MVR rates in England and declining rates in Scotland. Among 11–18-year-olds, MVR rates declined more steeply in Scotland than in England along with declines in non-MVR trends. CONCLUSIONS: Diverging trends in England and Scotland may reflect true changes in the occurrence of MVR injury or differences in the way services recognise and respond to these children, record such injuries or a combination of these factors. Further linkage of data from surveys and services for child maltreatment and violence could help distinguish the impact of policies.