Background

International Classification of Diseases (ICD) billing codes are not well-suited to estimate physical abuse prevalence among hospitalized patients and may be even less accurate in emergency departments (EDs). The Centers for Disease Control and Prevention (CDC) has recently published a child abuse and neglect syndromic surveillance definition to more accurately examine national abuse trends among ED visits.

Objective

To retrospectively apply the CDC syndromic definition to a population of physically abused children and determine its sensitivity for abuse in an ED and at hospital discharge.

Participants and Setting.

All physically abused children <5 years seen in the ED and evaluated by the child protection team from 2016 to 2020 at a large Midwestern children's hospital.

Methods

Retrospective cross-sectional study utilizing the hospital's child protection team administrative database, the Pediatric Health Information System and the electronic health record to identify the study sample, chief complaint, and abuse-specific codes assigned in the ED and at hospital discharge. Abuse-specific codes were defined as all ICD-10-CM and Systematized Nomenclature of Medicine – Clinical Terms (SNOMED CT) codes included in the CDC syndromic definition, which was applied to the sample and its sensitivity determined.

Results

Among the 550 abused patients identified, most were male (58.4 %), white (65.1 %), <2 years old (80.4 %), and had public insurance (81.6 %). When applying the CDC syndromic definition, only 11.6 % were identified as abused in the ED and 65.3 % were identified at hospital discharge.

Conclusions

The CDC syndrome surveillance definition lacks sensitivity in identifying abuse in the ED or at hospital discharge.

中文翻译：

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诊断代码大大低估了滥用的负担

背景

国际疾病分类 (ICD) 计费代码不太适合估计住院患者的身体虐待患病率，在急诊室 (ED) 中可能更不准确。疾病控制和预防中心 (CDC) 最近发布了一项儿童虐待和忽视综合症监测定义，以更准确地检查急诊就诊中的全国虐待趋势。

客观的

回顾性地将 CDC 综合征定义应用于身体受虐儿童群体，并确定其在急诊室和出院时对虐待的敏感性。

参与者和设置。

2016 年至 2020 年，所有在中西部一家大型儿童医院的急诊室就诊并由儿童保护小组评估的 5 岁以下遭受身体虐待的儿童。

方法

回顾性横断面研究，利用医院的儿童保护团队管理数据库、儿科健康信息系统和电子健康记录来确定研究样本、主诉和在急诊室和出院时分配的虐待特定代码。滥用特定代码被定义为所有 ICD-10-CM 和系统化医学命名法 - 临床术语 (SNOMED CT) 代码，包括在 CDC 综合征定义中，应用于样本并确定其敏感性。

结果

在确定的 550 名受虐患者中，大多数是男性 (58.4%)、白人 (65.1%)、<2 岁 (80.4%) 和有公共保险 (81.6%)。当应用 CDC 综合征定义时，只有 11.6% 被确定为在 ED 中被滥用，而 65.3% 在出院时被确定为滥用。

结论

CDC 综合征监测定义在识别急诊室或出院时的虐待方面缺乏敏感性。