Identification of Child Maltreatment-Related Emergency Department Visits in Connecticut, 2011 to 2014

Area of Science:

• Public Health
• Pediatrics
• Medical Informatics

Background:

• Child maltreatment identification by medical professionals is often underrepresented in child protection records.
• International Classification of Disease, Ninth Revision, Clinical Modification (ICD-9-CM) codes offer a potential alternative for capturing maltreatment treated in clinical settings.

Purpose of the Study:

• To enumerate child maltreatment presentations treated in Connecticut emergency departments (EDs) using ICD-9-CM codes.
• To compare the prevalence and characteristics of maltreatment identified through explicit documentation versus ICD-9-CM codes.

Main Methods:

• Analysis of emergency department discharge data from Connecticut from 2011 to 2014 for children under 10 years.
• Enumeration of ED visits with explicit documentation of child maltreatment.
• Identification of ED visits with ICD-9-CM codes suggestive of maltreatment.

Main Results:

• Explicit documentation identified 265 cases (0.03%) of child maltreatment among 790,080 discharges.
• A total of 3,634 visits included ICD-9-CM codes suggestive of maltreatment.
• Children with suggestive ICD-9-CM codes were younger, more likely white, and had private insurance.

Conclusions:

• ICD-9-CM codes provide a more comprehensive measure of child maltreatment burden treated in clinical settings compared to explicit documentation alone.
• Utilizing ICD codes in child maltreatment surveillance can reveal characteristics not captured by traditional child welfare data.
• Combining explicit and suggestive ICD codes is crucial for a fuller understanding of child maltreatment extent.