Quantity of documentation of maltreatment risk factors in injury-related paediatric hospitalisations

Abstract

BackgroundWhile child maltreatment is recognised as a global problem, solid epidemiological data on the prevalence of child maltreatment and risk factors associated with child maltreatment is lacking in Australia and internationally. There have been recent calls for action to improve the evidence-base capturing and describing child abuse, particularly those data captured within the health sector. This paper describes the quantity of documentation of maltreatment risk factors in injury-related paediatric hospitalisations in Queensland, Australia.MethodsThis study involved a retrospective medical record review, text extraction and coding methodology to assess the quantity of documentation of risk factors and the subsequent utility of data in hospital records for describing child maltreatment and data linkage to Child Protection Service (CPS).ResultsThere were 433 children in the maltreatment group and 462 in the unintentional injury group for whom medical records could be reviewed. Almost 93% of the maltreatment code sample, but only 11% of the unintentional injury sample had documentation identified indicating the presence of any of 20 risk factors. In the maltreatment group the most commonly documented risk factor was history of abuse (41%). In those with an unintentional injury, the most commonly documented risk factor was alcohol abuse of the child or family (3%). More than 93% of the maltreatment sample also linked to a child protection record. Of concern are the 16% of those children who linked to child protection who did not have documented risk factors in the medical record.ConclusionGiven the importance of the medical record as a source of information about children presenting to hospital for treatment and as a potential source of evidence for legal action the lack of documentation is of concern. The details surrounding the injury admission and consideration of any maltreatment related risk factors, both identifying their presence and ruling them out are required for each and every case. This highlights the need for additional training for clinicians to understand the importance of their documentation in child injury cases.

Child, parent and contextual factors associated with child protection system involvement and child maltreatment in the family: A rapid evidence review

“…Prior maltreatment experiences, such as neglect (White et al., 2015), exposure to family violence (Frederico et al., 2014) or having a history of foster care or group home placements (McKenzie & Scott, 2012; Sinha et al., 2013), were associated with a higher likelihood for further victimisation. Young children seemed to be at a greater chance for most maltreatment types, including traumatic brain injury due to child maltreatment (Ayton et al., 2021), filicide (Brown et al., 2014) and exposure to domestic violence (Dodaj, 2020) and were more likely to be placed in care due to neglect, domestic violence, financial and housing difficulties, parental substance abuse, parental physical illness or disability (Fernandez et al., 2019; Scott, 2015).…”

“…Parents' own experiences of child sexual abuse (Cale et al., 2021) or family violence (Ayton et al., 2021; Cale et al., 2021; Kaltner, 2013; Meiksans et al., 2021; Montgomery et al., 2019; Sachmann & Harris Johnson, 2014; Sumner et al., 2015; White et al., 2015) were also associated with a higher likelihood of maltreatment for their children. Previous child protection contacts both for parents (“intergenerational” involvement) and for children (either earlier contacts for the same child, or for siblings) were associated with higher likelihoods of further harm (Fogarty et al., 2022; Lennings et al., 2014; McKenzie & Scott, 2012; Schneeberger et al., 2014).…”

Predictive value of indicators for identifying child maltreatment and intimate partner violence in coded electronic health records: a systematic review and meta-analysis

“…In total, 65 cross-sectional and 23 longitudinal studies (81 unique publications), involving 20 indicators and 3 875 183 individuals from 11 different countries met the inclusion criteria ( figure 1 ). Overall, 13 studies provided indicators for NAS, 36–45 7 for FAS, 46–52 50 for CM (0–18 years) 14 53–98 and 18 for IPV among women (12–50 years). 99–116 Most studies were from the USA (72 studies, 81%), with a minority from Australia (8 studies, 9%) and Europe (4 studies, 4%).…”

“… 11–13 However, the potential utility of EHRs to support surveillance and clinical decisions is often undermined by reported quality issues and coded conditions are rarely validated externally. 14 15 Unable to check the data themselves for accuracy, large-scale studies (eg, Global Burden of Disease Study) and services rely on routinely coded indicators based on the International Classification of Diseases (ICD) with unknown predictive values. 10 16 17 The validity of coded indicators are compounded by varying case definitions, ad hoc classifications by coders 5 15 18–20 and under-recording due to clinician fears of potential harm or lack of awareness.…”

Dysfunction of Serotonergic and Dopaminergic Neuronal Systems in the Antidepressant-Resistant Impairment of Social Behaviors Induced by Social Defeat Stress Exposure as Juveniles

“…Adverse juvenile experiences, including physical or sexual violence and neglect, often induce adverse mental health outcomes later in life ( Afifi, 2011 ; Annerback et al, 2012 ; McKenzie and Scott, 2012 ). Epidemiological studies have demonstrated that adverse juvenile experiences increase the risk for stress-related psychiatric disorders, particularly major depressive disorder (MDD), anxiety disorder, and posttraumatic stress disorder ( Weber et al, 2008 ; Weich et al, 2009 ; McLaughlin et al, 2010 ).…”