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Child maltreatment surveillance following the ICD-10-CM transition, 2016-2018
  1. Amy A Hunter1,2,3,
  2. Nina Livingston3,
  3. Susan DiVietro1,3,
  4. Laura Schwab Reese4,
  5. Kathryn Bentivegna5,
  6. Bruce Bernstein6
  1. 1Injury Prevention Center, Connecticut Children’s and Hartford Hospital, Hartford, Connecticut, USA
  2. 2Department of Public Health Sciences, University of Connecticut, Farmington, Connecticut, USA
  3. 3Department of Pediatrics, University of Connecticut, Connecticut Children’s, Hartford, Connecticut, USA
  4. 4Department of Health and Kinesiology, Purdue University, West Lafayette, Indiana, USA
  5. 5School of Medicine, University of Connecticut, Farmington, Connecticut, USA
  6. 6School of Medicine, Drexel University, Philadelphia, Pennsylvania, USA
  1. Correspondence to Dr Amy A Hunter, Injury Prevention, Connecticut Children's Medical Center, Hartford, CT 06106, USA; ahunter{at}


Background Child maltreatment is poorly documented in clinical data. The International Classification of Diseases and Related Health Problems, 10th Revision, Clinical Modification (ICD-10-CM) represents the first time that confirmed and suspected child maltreatment can be distinguished in medical coding. The utility of this distinction in practice remains unknown. This study aims to evaluate the application of these codes by patient demographic characteristics and injury type.

Methods We conducted 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).

Results From 2016 to 2018, child maltreatment was documented in 1650 unique ED visits, or 21.7 per 10 000 child ED visits. Suspected maltreatment was documented most frequently (58%). Half of all maltreatment-related visits involved sexual abuse, most often in females and individuals of non-Hispanic white race. Physical abuse was coded in 36% of visits; injuries to the head were predominant. Non-Hispanic black children were more frequently documented with confirmed physical abuse than suspected (38.7% vs 23.7%, p<0.01). The rate of co-occurring injuries documented with confirmed and suspected maltreatment differed by 30% (9.2 vs 12.5 per 10 000 ED visits, respectively).

Conclusions The ability to discriminate confirmed and suspected maltreatment may help mitigate clinical barriers to maltreatment surveillance associated with delayed diagnosis and subsequent intervention. Racial disparities in suspected and confirmed cases were identified which may indicate biased diagnostic behaviours in the ED.

  • child abuse
  • surveillance
  • epidemiology
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  • Correction notice The article has been corrected since it is published online. In the first paragraph of the Results, the percentages for physical abuse and sexual abuse have been corrected.

  • Contributors AAH conceptualised the idea for this research, conducted the statistical analysis and contributed significantly to the writing. NL provided clinical expertise and contributed significantly to the writing. LSR, SD, KB and BB participated in the interpretation of results and drafting of the final manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting or dissemination plans of this research.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data may be obtained from a third party and are not publicly available. Data for this analysis were obtained from the Connecticut Hospital Association and may be available upon request.

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