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Rates and types of hospitalisations for children who have subsequent contact with the child protection system: a
M O'Donnell1, N Nassar, H Leonard
1Telethon Institute for Child Health Research, 100 Roberts Road, Subiaco, Perth, Western Australia 6008, Australia. melissao@ichr.uwa.edu.au
Insights
Children with documented maltreatment allegations or substantiations experienced higher rates of hospital admissions, including for injuries, infections, and mental health issues. This highlights the hospital system
Area of Science:
- Child Health Surveillance
- Public Health
- Pediatric Medicine
Background:
- Child maltreatment poses significant risks to a child's health and safety.
- Understanding patterns of healthcare utilization can aid in identifying at-risk children.
- Previous research has explored links between specific injuries and maltreatment, but broader admission patterns require further investigation.
Purpose of the Study:
- To compare general and injury-related hospital admission rates in children with maltreatment allegations/substantiations versus controls.
- To investigate associations between other admission types (mental health, infections, external causes) and child maltreatment.
- To assess the predictive value of prior hospital admission rates on the risk of child maltreatment allegations and substantiations.
Main Methods:
- A prospective, matched case-control study design was employed.
- Data from de-identified, record-linked Child Protection and Hospital Morbidity records for children born in Western Australia (1990-2005) were analyzed.
- Conditional logistic regression was used to analyze the relationship between admission rates and the risk of child maltreatment.
Main Results:
- Children with child maltreatment allegations and substantiations exhibited higher mean prior hospital admission rates compared to control groups.
- Elevated rates of general admissions, and admissions for injuries, infections, mental/behavioral disorders, and external causes were significantly associated with increased risk of maltreatment allegations and substantiations.
- Specific admission types, particularly injuries and behavioral issues, strongly correlated with subsequent maltreatment findings.
Conclusions:
- The hospital system is crucial for both surveillance and prevention of child maltreatment, identifying families needing support.
- Utilizing electronic patient records can help identify children with high admission rates and specific concerning conditions.
- Focusing on injuries, mental/behavioral disorders, and external causes of admissions can improve early identification of at-risk children.
Objectives:
To determine whether children who have child maltreatment allegation or substantiation have a higher rate of general hospital admissions and injury related admissions when compared to other children and to investigate other types of admissions, such as mental health, infections and admissions due to external causes.
Study Design:
A prospective matched case-control study of children born in Western Australia between 1990 and 2005 using de-identified record linked Child Protection and Hospital Morbidity data. Rates of prior hospital admissions for cases versus controls were calculated, and conditional logistic regression was used to estimate the effect of hospital admission rate on the risk of child maltreatment allegation and substantiated allegation.
Results:
Children with child maltreatment allegations and substantiations had higher mean prior admission rates compared to controls. Higher rates of general admissions and admissions for injuries, infections, mental and behavioural disorders, and external causes of morbidity, were associated with a markedly increased risk of child maltreatment allegations and substantiation.
Conclusions:
The hospital system plays not only an important role both in the surveillance of maltreatment-related injuries and conditions but also in the role of prevention in the referral of families who may need support and assistance in ensuring the health and safety of their children. This research highlights the importance of moving to electronic patient records in identifying children who have high rates of admissions and the types of conditions they have previously presented with, particularly for injuries, mental and behavioural disorders and external causes of admissions.
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