Related Experiment Video
Updated: Dec 12, 2025
Handheld Metal Detector Screening for Metallic Foreign Body Ingestion in Children
Published on: September 11, 2018
Hospital Injury Encounters of Children Identified by a Predictive Risk Model for Screening Child Maltreatment
Rhema Vaithianathan1, Emily Putnam-Hornstein2, Alexandra Chouldechova3
1Auckland University of Technology, Auckland, New Zealand.
Insights
Predictive risk models (PRMs) identifying children at high risk for foster care also predict increased injury hospitalizations. This highlights the utility of PRMs in child protection for identifying vulnerable children needing medical attention.
Area of Science:
- Child welfare research
- Public health
- Data science in social services
Background:
- Child protection agencies utilize predictive risk models (PRMs) to identify children at risk of future adverse outcomes based on administrative data.
- These PRMs generate risk stratification scores, primarily used to predict foster care placement.
- The effectiveness of PRMs in predicting other adverse outcomes, such as injury hospitalizations, remains an area for investigation.
Purpose of the Study:
- To evaluate whether a PRM, used for predicting foster care placement, can also predict injury hospitalization data in children referred for alleged maltreatment.
- To assess the association between PRM-generated risk scores and subsequent medical encounters for various types of injuries.
Main Methods:
- A retrospective cohort study was conducted using linked child protection and hospital encounter data in Allegheny County, Pennsylvania.
- Participants included over 47,000 children referred for alleged abuse or neglect between 2010 and 2016.
- The study analyzed medical encounters for any-cause injuries, abuse injuries, and self-harm injuries, comparing rates between high-risk and low-risk groups identified by the PRM.
Main Results:
- Children in the highest 5% risk group identified by the PRM had significantly higher rates of medical encounters for any-cause injuries compared to low-risk children (14.5 vs. 4.9 per 100).
- High-risk children also showed elevated rates for abuse-associated injuries (2.0 vs. 0.2 per 100) and suicide/self-harm injuries (1.0 vs. 0.1 per 100).
- No association was found between PRM risk scores and cancer encounters, serving as a placebo test.
Conclusions:
- The study confirms that PRMs used in child protection are effective in identifying children at high risk not only for foster care but also for subsequent injury hospitalizations.
- These findings underscore the value of PRMs in child welfare systems for proactively identifying children who may require medical intervention.
- The results suggest that PRM risk scores can serve as an important indicator for potential physical harm in children investigated for maltreatment.
Importance:
Nearly 6 million children are reported as allegedly experiencing abuse or neglect in the US annually. Child protection agencies are increasingly turning to automated predictive risk models (PRMs) that mine information found in routinely collected administrative data and estimate a likelihood that an individual will experience some future adverse outcome.
Objective:
To test if a PRM used at the time of referral for alleged maltreatment, which automatically generates a risk stratification score indicating the relative likelihood of future foster care placement, is also predictive of injury hospitalization data.
Design, Setting, And Participants:
This retrospective cohort study based on a probabilistic association between child protection and hospital encounter data was conducted in Allegheny County, Pennsylvania, and at Children's Hospital of Pittsburgh (Pittsburgh, Pennsylvania). Participants included children referred for alleged neglect or abuse in Allegheny County between April 1, 2010, and May 4, 2016.
Exposures:
Risk score generated from the PRM.
Main Outcomes And Measures:
Medical encounters (emergency department and inpatient hospitalizations) for any-cause injuries, suicide or self-inflicted harm injuries, and abuse injuries between 2002 and 2015 for children classified by the PRM to different risk levels at the time of a maltreatment referral. Cancer encounters were used as a placebo test.
Results:
Of 47 305 participants, 23 601 (49.9%) were girls, the mean (SD) age at referral was 8 (5.7) years, 28 211 (59.6%) were black, and 19 094 (40.4%) were nonblack. Children who scored in the highest 5% risk group by the PRM were more likely to have a medical encounter for an injury during the follow-up period than low-risk children (ie, those in the bottom 50% of risk). Specifically, among children referred for maltreatment and classified as highest risk, the rate of experiencing an any-cause injury encounter was 14.5 (95% CI, 13.1-15.9) per 100 compared with children who scored as low risk who had an any-cause injury encounter rate of 4.9 (95% CI, 4.7-5.2) per 100. For abuse-associated injury encounters, the rate for high-risk children was 2.0 (95% CI, 1.5-2.6) per 100 and that of low-risk children was 0.2 (95% CI, 0.2-0.3) per 100; for suicide and self-harm, the high-risk encounter rate was 1.0 (95% CI, 0.6-1.4) per 100 and that of low-risk children was 0.1 (95% CI, 0.1-0.1) per 100. There was no association between risk scores and cancer encounters.
Conclusions And Relevance:
Findings confirm that children reported for having experienced alleged maltreatment and classified by a PRM tool to be at high risk of foster care placement are also at increased risk of emergency department and in-patient hospitalizations for injuries.
