The purpose of this study was to identify the number of children (<18years old) with an International Classification of Disease (ICD) diagnosis code for child maltreatment each year from 2001–2018 and examine differences by age, gender, and race/ethnicity. Data were drawn from the electronic health records of children (birth to <18years old) who were members of a large integrated healthcare system in California. We calculated the incidence rate (1 per 1000 children) for each year from 2001–2018 separately by age groups, gender, and race/ethnicity. Adolescents (11–15years old) had the overall highest incidence of all ages groups. Females had nearly twice the rate of males for the past 5years. Lastly, for race/ethnicity Black children had the highest incidence and Asian children the lowest. The findings demonstrate that maltreatment diagnosis in medical settings may be underused. Understanding the trends of these ICD codes by demographic characteristics yields information that health care providers may use to both increase the identification and documentation of child maltreatment.
AdamsJAFarstKJKelloggND, et al. (2018) Interpretation of medical findings in suspected child sexual abuse: an update for 2018. Journal of Pediatric and Adolescent Gynecology31: 225–231.
2.
BentivegnaKDuranteALivingstonN, et al. (2019) child sexual abuse identified in emergency departments using ICD-9-CM, 2011 to 2014. The Journal of Emergency Medicine56: 719–726.
3.
BrownSMRienksSMcCraeJS, et al. (2019) The co-occurrence of adverse childhood experiences among children investigated for child maltreatment: a latent class analysis. Child Abuse & Neglect87: 18–27.
4.
ChangDCKnightVZiegfeldS, et al. (2004) The tip of the iceberg for child abuse: the critical roles of the pediatric trauma service and its registry. Journal of Trauma and Acute Care Surgery57: 1189–1198.
5.
DrakeBJolleyJMLanierP, et al. (2011) Racial bias in child protection? A comparison of competing explanations using national data. Pediatrics127: 471–478.
6.
FangXBrownDSFlorenceCS, et al. (2012) The economic burden of child maltreatment in the United States and implications for prevention. Child Abuse & Neglect36: 156–165.
7.
FarstKAmbadwarPBKingAJ, et al. (20131997-2009) Trends in hospitalization rates and severity of injuries from abuse in young children. Pediatrics131: e1796–e1802.
8.
FinkelhorDTurnerHAShattuckA, et al. (2015) Prevalence of childhood exposure to violence, crime, and abuse: results from the national survey of children’s exposure to violence. JAMA Pediatrics169: 746–754.
9.
FlahertyEG (2015) Practical issues and challenges for physicians reporting suspected child maltreatment. In:Mandatory Reporting Laws and the Identification of Severe Child Abuse and Neglect. Dordrecht: Springer, pp. 311–325.
10.
FlahertyEGSegeRDGriffithJW, et al. (2008) From suspicion of physical child abuse to reporting: primary care clinician decision-making. Pediatrics122: 611–619.
11.
ForjuohSN (2000) Child maltreatment related injuries: incidence, hospital charges, and correlates of hospitalization. Child Abuse & Neglect24: 1019–1025.
12.
FriedmanLSSheppardSFriedmanD, et al. (2012) A retrospective cohort study of suspected child maltreatment cases resulting in hospitalization. Injury43: 1881–1887.
13.
HegerATicsonLVelasquezO, et al. (2002) Children referred for possible sexual abuse: medical findings in 2384 children. Child Abuse & Neglect26: 645–659.
14.
HudsonMKaplanR (2006) Clinical response to child abuse. Pediatric Clinics of North America53: 27–39.
15.
IbanezESBorregoJJrPembertonJR, et al. (2006) Cultural factors in decision-making about child physical abuse: identifying reporter characteristics influencing reporting tendencies. Child Abuse & Neglect30: 1365–1379.
16.
Jonson-ReidMKohlPLDrakeB, et al. (2012) Child and adult outcomes of chronic child maltreatment. Pediatrics129: 839–845.
17.
KaratekinCAlmyBMasonSM, et al. (2018) Documentation of child maltreatment in electronic health records. Clinical Pediatrics57: 1041–1052.
18.
KelloggND (2007) Evaluation of suspected child physical abuse. Pediatrics119: 1232–1241.
19.
KimKMennenFETrickettPK, et al. (2017) Patterns and correlates of co-occurrence among multiple types of child maltreatment. Child and Family Social Work22: 492–502.
20.
KingAJFarstKJJaegerMW, et al. (2015) Maltreatment-related emergency department visits among children 0 to 3 years old in the United States. Child Maltreatment20: 151–161.
21.
KoebnickCLanger-GouldAMGouldMK, et al. (2012) Sociodemographic characteristics of members of a large, integrated health care system: comparison with US Census Bureau data. The Permanente Journal16: 37–41.
22.
McKenzieKScottDA (2011) Using routinely collected hospital data for child maltreatment surveillance: issues, methods and patterns. BMC Public Health11: 1–10.
23.
NajdowskiCJBernsteinKM (2018) Race, social class, and child abuse: content and strength of medical professionals’ stereotypes. Child Abuse & Neglect86: 217–222.
24.
PalusciVJBotashAS (2021) Race and bias in child maltreatment diagnosis and reporting. Pediatrics148: e2020049625.
25.
RaghavanRBrownDSAllaireBT, et al. (2015) Challenges in using medicaid claims to ascertain child maltreatment. Child Maltreatment20: 83–91.
26.
RavichandiranNSchuhSBejukM, et al. (2010) Delayed identification of pediatric abuse-related fractures. Pediatrics125: 60–66.
27.
RojasMWalker-DescartesILaraque-ArenaD, et al. (2017) An experimental study of implicit racial bias in recognition of child abuse. American Journal of Health Behavior41: 358–367.
28.
RoviSChenPHJohnsonMS, et al. (2004) The economic burden of hospitalizations associated with child abuse and neglect. American Journal of Public Health94: 586–590.
29.
RoviSJohnsonMS (2003) More harm than good? Diagnostic codes for child and adult abuse. Violence and Victims18: 491–502.
30.
SchnitzerPGSlusherPVan TuinenM, et al. (2004) Child maltreatment in Missouri: combining data for public health surveillance. American Journal of Preventive Medicine27: 379–384.
31.
ScottDTonmyrLFraserJ, et al. (2009) The utility and challenges of using ICD codes in child maltreatment research: a review of existing literature. Child Abuse & Neglect33: 791–808.
32.
SedlakAJMettenburgJBasenaM, et al. (2010) Fourth National Incidence Study of Child Abuse and Neglect (NIS-4). Washington, DC: US Department of Health and Human Services. Retrieved on July 9: 2010.
33.
ShonkoffJPGarnerASSiegelBSCommittee on psychosocial aspects of child and family health, et al. (2012) The lifelong effects of early childhood adversity and toxic stress. Pediatrics129: e232–e246.
34.
SkellernCYWoodDOMurphyA, et al. (2000) Non-accidental fractures in infants: risk of further abuse. Journal of Paediatrics and Child Health36: 590–592.
WildemanCEmanuelNLeventhalJM, et al. (2014) The prevalence of confirmed maltreatment among US children, 2004 to 2011. JAMA Pediatrics168: 706–713.
37.
WinnDGAgranPFAndersonCL, et al. (1995) Sensitivity of hospitals’ E-coded data in identifying causes of children's violence-related injuries. Public Health Reports110: 277–281.
38.
ZayasLH (1992) Childrearing, social stress, and child abuse: clinical considerations with Hispanic families. Journal of Social Distress and the Homeless1: 291–309.
39.
ZhaiFGaoQ (2009) Child maltreatment among Asian Americans: characteristics and explanatory framework. Child Maltreatment14: 207–224.
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