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OBJECTIVE: To prevent missed cases and standardize care, health systems are beginning to implement EHR-based screens (EHR-CA-S) and clinical decision supports systems (EHR-CA-CDSS) for the identification and management of child maltreatment. This study aimed to 1) document the existing research evidence on the performance of EHR-CA-S and EHR-CA-CDSS and 2) examine clinical perspectives regarding the use of such tools and factors that affect uptake. METHODS: We searched MEDLINE, Embase, EBSCO, Scopus, and CINAHL databases for English language articles published prior to November 2021 that describe and/or evaluated an EHR-CA-S and/or EHR-CA-CDSS involving 0 to 18-year olds. We performed semistructured interviews with 20 individuals who have experience in identifying, evaluating, and/or treating child maltreatment and/or conducting research on these topics. RESULTS: Our search identified 574 articles; 16 met inclusion criteria. Studies examined screening, alerts and triggers, and quality improvement. None evaluated long-term clinical outcomes. Sensitivity ranged from 0.14 to 1.00, specificity from 0.865 to 1.00, positive predictive value from 0.03 to 1.00 and negative predictive value from 0.55 to 1.00. A variety of EHR-CA-S and/or EHR-CA-CDSS have been implemented at institutions in our sample. Interviewees cited missed cases, policy requirements, and the lack of standardization of care as impetuses for adopting these tools, yet expressed concerns regarding insufficient evidence, bias, and time-intensiveness of implementation. CONCLUSIONS: Interviewees and the literature agree that current evidence does not support adoption of a particular CA-S or CA-CDSS. Further refinement and research on EHR-CA-S and EHR-CA-CDSS is necessary for these tools to be feasibly implemented and sustained, reliable for clinical practice, and not cause any unintentional harms. [ABSTRACT FROM AUTHOR]

• First scoping review on ICD codes for suspected child maltreatment. • Researchers employed different strategies for selecting ICD codes. • Most research on abusive head trauma applied the same set of ICD codes. • Only 10% of the studies estimated the sensitivity and specificity of ICD codes. • Compiled an extensive list of ICD codes for suspected maltreatment. Administrative medical records and claims are increasingly used to study prevalence of and outcomes for children exposed to child maltreatment. However, suspicion of child maltreatment is often under-documented in medical records using International Classification of Diseases (ICD) codes. Although researchers have developed strategies to more broadly capture the injuries, illnesses, and circumstances that are suggestive of maltreatment, there is no consensus on which codes to use for this purpose. To systematically examine the types of research being conducted with ICD codes related to suspected maltreatment, summarize ICD codes for suspected maltreatment, synthesize the strategies researchers employed to identify the codes, and propose future direction. We searched five electronic databases for studies that reported ICD codes suggestive of child maltreatment in any medical setting, included participants aged 0–18 years, and published in a peer-reviewed journal in English. Two reviewers independently screened the titles, abstracts, and the full texts. Data were synthesized in a qualitative manner. This review was guided by the PRISMA extension for scoping reviews. Thirty-seven studies met inclusion criteria. Most studies focused on determining the incidence or trends of maltreatment-related injuries or illnesses. Studies varied greatly in the codes used to identify suspected maltreatment. Only four articles reported on the validation of selected codes. ICD codes for transport accidents were the most frequently excluded co-occurring codes. Studies frequently relied on two seminal studies and two national-level guidelines. Substantial heterogeneity existed in the ICD codes and strategies used to identify suspected maltreatment. The age range for codes, excluded co-occurring codes, and validation of codes are areas future research should address. This review may reduce costs for future researchers so that they could choose optimal measures of suspected maltreatment from our summarized list of codes without reinventing the wheel. Our review provides a basis for the development of recommended guidelines in establishing uniform codes for suspected maltreatment that could promote public health surveillance and allow for more efficient and uniform policy or program evaluation. [ABSTRACT FROM AUTHOR]

Child maltreatment leads to substantial adverse health outcomes, but little is known about acute health care utilization patterns after children are evaluated for a concern of maltreatment at a child abuse and neglect medical evaluation clinic. To quantify the association of having a child maltreatment evaluation with subsequent acute health care utilization among children from birth to age three. Children who received a maltreatment evaluation (N = 367) at a child abuse and neglect subspecialty clinic in an academic health system in the United States and the general pediatric population (N = 21,231). We conducted a retrospective cohort study that compared acute health care utilization over 18 months between the two samples using data from electronic health records. Outcomes were time to first emergency department (ED) visit or inpatient hospitalization, maltreatment-related ED use or inpatient hospitalization, and ED use or inpatient hospitalization for ambulatory care sensitive conditions (ACSCs). Multilevel survival analyses were performed. Children who received a maltreatment evaluation had an increased hazard for a subsequent ED visit or inpatient hospitalization (hazard ratio [HR]: 1.3, 95 % confidence interval [CI]: 1.1, 1.5) and a maltreatment-related visit (HR: 4.4, 95 % CI: 2.3, 8.2) relative to the general pediatric population. A maltreatment evaluation was not associated with a higher hazard of health care use for ACSCs (HR: 1.0, 95 % CI: 0.7, 1.3). This work can inform targeted anticipatory guidance to aid high-risk families in preventing future harm or minimizing complications from previous maltreatment. [ABSTRACT FROM AUTHOR]