The 131st Annual Meeting (November 15-19, 2003) of APHA

Abstract #70923

Paula Slusher, RN, MSN¹, Patricia G. Schnitzer, PhD¹, Kristina Szafara, PhD¹, Molly Malone, RN, BSN¹, and Mark Van Tuinen, PhD². (1) Family & Community Medicine, University of Missouri-Columbia, MA306 Medical Sciences Building DC032.00, Columbia, MO 65212, (2) Missouri Department of Health and Senior Services, PO Box 570, 920 Wildwood, Jefferson City, MO 65102

Purpose: We assessed the accuracy of ICD-9-CM maltreatment codes applied to one year of hospital discharge and emergency department (ED) data in Missouri. Methods: A 10% random sample was selected from all maltreatment-coded hospital/ED visits by children under 10 years old in the year 2000. Letters were sent to hospitals requesting access to the medical record for the visits sampled. We reviewed these medical records to determine the accuracy of the maltreatment codes assigned. Maltreatment codes were considered valid if it was documented that the child presented for care with an allegation of maltreatment or the medical provider suspected maltreatment during the history and physical assessment. Results: The sample consisted of 128 maltreatment-coded visits. Of these, 127 records were available for review. Maltreatment was documented in 110 (87%) of the 127 visits. Allegation of maltreatment occurred in 80 (73%) of the visits, while suspicion of maltreatment accounted for the other 30 (27%). Typically, suspicion of maltreatment was documented when physical evidence of an injury was found but unexplained (50%), or when the mechanism of injury was inconsistent with the clinical presentation (40%). Notification of child protective services was documented in a majority of the charts (103 of 110). Seventeen visits (13%) from the original 127 were not related to a maltreatment incident; they were associated with maltreatment that had occurred in the past. Conclusion: ICD-9-CM maltreatment codes were validly applied in these hospital emergency department data. However, not all codes reflected current or incident maltreatment.

Learning Objectives:

1. Recognize that ICD-9-CM maltreatment codes were validly applied to one sample of hospital and emergency department data. 2. Describe the limitations of using ICD-9-CM maltreatment codes to capture incidence maltreatment.
• Discuss the different types of information documented in the medical records of ICD- 9-CM maltreatment-coded visits.

Keywords: Data/Surveillance, Child Health

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.