Leveraging Hospital Records to Examine Child Maltreatment Risk


In order to form a more complete picture of the characteristics and public service trajectories of Rady Children Hospital – San Diego (RCHSD) patients, we matched administrative child protective service (CPS) records from San Diego county with health encounter records from RCHSD for the cohort for all children born 2010-2014. Child protection and health care encounter data spanned the period from 2010-2016 and included information concerning the timing and type of referrals of alleged maltreatment. After records were linked, ICD-9 and 10 codes were used to document healthcare encounters. Records were coded using Schnitzer’s (2011) condensed list of ICD codes that are suggestive or confirmatory of a medical encounter for child abuse or neglect. Using these linked records, we produced descriptive statistics about our population and examined the nature of medical encounters that led to official reports of maltreatment, identifying characteristics that affected reporting likelihood; and used medical data to validate assessed differences in risk among children reported to CPS for abuse / neglect.

Overview of Findings

Preliminary findings indicate that 19.7% of young patients (those born 2010-2014 and followed until around age 5) at RCHSD had >=1 reports of alleged maltreatment reports made to CPS. This aligns with statewide / non-medical sample estimates generated by the research team. Second, among children with a documented encounter coded as maltreatment (suggested/confirmed) at RCHSD, 84.9% were also reported to CPS. Third, from the perspective of the local child protection agency, among children who were born in San Diego between 2010-2014 and reported for maltreatment, 61% had a medical encounter with RCHSD.

Our examination of risk differences based on a proposed CPS model for stratifying children at the time a report of maltreatment is received and hospital-based injury encounters suggests a strong association between CPS model risk stratification with maltreatment-related injuries. Findings from linked records in San Diego suggest that most children with a medical encounter suggestive of abuse/neglect were reported to CPS. Findings also validate a model trained to predict future CPS involvement. Specifically, the data clearly indicate that maltreatment injuries are a credible indicator of child harm. We also found strong alignment between codes suggestive of maltreatment and risk scores.


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