Identification of Child-Maltreatment-Related Emergency Department Visits From Electronic Health Records
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Margaret L Holland1, Amy A Hunter2, Nina Livingston3
1Department of Population Health & Leadership (ML Holland), University of New Haven, West Haven, CT; Child Study Center (ML Holland), Yale University, New Haven, CT.
Insights
Combining ICD-10-CM codes with keywords and chief complaints in electronic health records significantly improves the identification of child maltreatment cases in emergency departments. Relying on a single method risks missing over a third of potential cases.
Area of Science:
- Medical Informatics
- Public Health
- Pediatrics
Background:
- Emergency department (ED) records with International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes are used to estimate child maltreatment prevalence.
- The efficacy of ICD-10-CM codes compared to other search strategies for identifying child maltreatment needs further evaluation.
Purpose of the Study:
- To compare the sensitivity and positive predictive values of ICD-10-CM codes, keywords in provider notes, and chief complaints in identifying child maltreatment in ED records.
- To assess the effectiveness of combining these search strategies.
Main Methods:
- A retrospective review of ED visits for suspected child maltreatment in children under 18 at two hospitals.
- Cases were identified using ICD-10-CM codes, keywords in provider notes, and chief complaints.
- ED provider notes were reviewed by clinicians to confirm maltreatment concerns, and sensitivity was calculated for each strategy.
Main Results:
- Of 3841 records, 1248 involved suspected maltreatment.
- ICD-10-CM codes alone had 47% sensitivity; keywords had 65% sensitivity; chief complaints had 58% sensitivity.
- Combining ICD-10-CM codes with keywords or chief complaints increased sensitivity to 82% and 77%, respectively.
Conclusions:
- Single search methods can miss 35-53% of child maltreatment cases.
- Combining multiple search strategies, including ICD-10-CM codes and text-based searches, enhances case identification.
- Further research is needed to refine these multi-modal search strategies for accurate child maltreatment surveillance.
Objective:
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.
Methods:
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.
Results:
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.
Conclusions:
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.
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