Identification of Child-Maltreatment-Related Emergency Department Visits From Electronic Health Records

Since the implementation of International Classification of Diseases and Related Health Problems, 10th Revision, Clinical Modification (ICD-10-CM) in 2015, emergency department (ED) records using expanded child maltreatment codes have been used to estimate the prevalence of child maltreatment in the United States. This study compares the efficacy of ICD-10-CM codes with other search strategies in identifying child maltreatment.

This study was conducted at Yale-New Haven Children's Hospital and Connecticut Children's Medical Center. We examined ED visits for confirmed or suspected child maltreatment concerns from January 1, 2019 to August 31, 2020 among children under 18 years old. Cases were identified using 3 search strategies: 1) ICD-10-CM codes, 2) keywords in provider notes, and 3) chief complaints. After cases were identified, ED provider notes were reviewed by clinicians to determine if a concern for maltreatment was indicated. Sensitivity and positive predictive values were calculated for each search strategy.

Of 3841 ED records identified by search strategies, 1248 were suspected to involve maltreatment. Using ICD-10-CM codes alone had a sensitivity of 47%; the sensitivity of keywords in provider notes and chief complaints were 65% and 58%, respectively. When ICD-10-CM codes were combined with keywords in provider notes and chief complaints, the sensitivity increased to 82% and 77%, respectively.

The use of any single method could miss 35% to 53% of cases, although time-consuming chart review was required to remove identified cases that were not associated with maltreatment. Future research should refine the search strategies and consider utilizing multiple approaches to identify cases.