ICD-10 Helps Show Prevalence of Child Maltreatment

By Lisa Rapaport

May 04, 2020

(Reuters Health) - Emergency department discharge records are starting to show the prevalence of child maltreatment now that the International Classification of Diseases and Related Health Problems, 10th Revision, Clinical Modification (ICD-10-CM) includes a dedicated code for this type of abuse, a U.S. study suggests.

Researchers conducted a secondary data analysis of emergency department (ED) discharge records of children under 18 years with an ICD-10-CM code for confirmed (T74) or suspected (T76) child maltreatment. Child age, sex, race, ethnicity, insurance status and co-occurring injuries (S00-T88) were compared by maltreatment type (confirmed or suspected).

There were 761,487 ED visits for children under 18 years from 2016 to 2018, the first three years after ICD-10 was adopted in the U.S. A total of 1,650 unique visits (0.2%) included documentation of suspected (949) or confirmed (698) child maltreatment. That translates into 21.7 cases of child maltreatment for every 10,000 ED visits.

"Improved documentation will support our surveillance efforts, and subsequently our understanding and approach to child maltreatment prevention," said lead study author Amy Hunter of Connecticut Children's and the University of Connecticut School of Medicine in Hartford.

"Because so many children are seen outside of the specialized pediatric setting, it is important to disseminate these results broadly so that all physicians working with children are empowered to use these codes to appropriately document maltreatment," Hunter said by email.

Nearly 2% (24) of maltreatment-related visits involved more than one type of documented abuse and neglect, the study found. Suspected maltreatment was documented more often (58%) than confirmed maltreatment.

Confirmed maltreatment was documented with other co-occurring injuries in 9.2 out of 10,000 ED visits, compared with 12.5 per 10,000 visits for suspected maltreatment.

Sexual (50.3%) and physical (36.7%) abuse were the most common forms of maltreatment documented. Sexual abuse was documented most often in females and individuals of non-Hispanic white race. In documented physical abuse, injuries to the head were predominant. Non-Hispanic black children were more frequently documented with confirmed physical abuse rather than suspected abuse (38.7% vs 23.7%).

When compared with suspected maltreatment, documentation of confirmed maltreatment involved children who were older (13 versus 6 years, respectively). The average age of children with confirmed physical abuse was 14 years, compared with 4 years among children with suspected physical abuse.

Due to the cross- sectional nature of the data, researchers were unable to establish a causal relationship between patient demographic characteristics and documented maltreatment type.

One limitation of the analysis is that the ICD-10-CM classification system was developed for the primary purpose of administrative billing, and not surveillance, limiting the level of specificity that can be gleaned from analyzing this data, researchers note in Injury Prevention.

"The ICD 10 includes formal permission to include suspected abuse, which is helpful in terms of making healthcare workers feel that they need to have legal proof that abuse has occurred," said Amy M. Smith Slep, a researcher at New York University, in New York City, who wasn't involved in the study.

"However, ICD 10 still does not include any criteria for determining what abuse or neglect is," Slep said by email. "This means how each clinician sees maltreatment can be (and is) affected by a range of biases and limitations."

Another significant challenge in this area is the practical and ethical issues regarding screening of individual patients, said Canan Karatekin, an associate professor at the Institute of Child Development at the University of Minnesota, in Minneapolis, who wasn't involved in the study.

"On the one hand, screening can save lives," Karatekin said by email. "On the other hand, it can also lead to more harm if adequate services are not provided after the screening and if identification of maltreatment leads to unnecessary stigmatization and discrimination."

By the time the maltreated children have come to the attention of the clinicians, maltreatment has already occurred, Karatekin also noted.

"All they can do, even if they become perfect in identifying and recording maltreatment, is to treat the consequences and to try to prevent it from happening again," Karatekin said. "What is more important is to take steps to prevent maltreatment in the first place, that is, primordial and primary prevention."

SOURCE: https://bit.ly/3bufxSp Injury Prevention, online April 1, 2020.