title: Child maltreatment in Missouri: combining data for public health surveillance.
abstract: BACKGROUND
  Public health surveillance was established for nonfatal child maltreatment in Missouri using two data sources. This paper describes the epidemiology of nonfatal child maltreatment using this surveillance system, and assesses the usefulness of combining medical data with child protective services (CPS) reports for child maltreatment surveillance.
  
  
  METHODS
  Child abuse and neglect reports for children aged <10 years for 2000 were obtained from the Missouri Division of Family Services (DFS) and linked to hospital discharge and emergency department (ED) data for 2000. Children were classified as maltreated if they had an International Classification of Disease (ICD) maltreatment code for a hospital or ED visit, or a substantiated report to DFS. Validity of the ICD maltreatment codes was assessed in a 10% random sample of the hospital/ED visits. Medical records were reviewed to determine the accuracy of the maltreatment code assigned. The data analyses reported here were conducted in 2002 and 2003.
  
  
  RESULTS
  In the linked data, 5657 children met the case definition of maltreatment, providing a nonfatal maltreatment rate of 7.4/1000 children. Rates were higher among children aged <1 year (8.4/1000), females (7.7/1000), African Americans (11.8/1000), and children residing in rural counties (8.7/1000). The hospital/ED data identified proportionately more children who were African American, urban, physically abused, or infants, and uniquely identified only 10% of the total cases. In the validation sample, maltreatment was documented in 110 (87%) of the 127 records reviewed.
  
  
  CONCLUSIONS
  CPS and medical data can be linked for surveillance. However, the medical data add few unique cases and identify only a subset of maltreated children.
authors.affiliation: Department of Family and Community Medicine, University of Missouri, Columbia, Missouri 65212, USA. schnitzerp@health.missouri.edu
authors.forename: Patricia G
authors.initials: PG
authors.lastname: Schnitzer
authors.forename: Paula
authors.initials: P
authors.lastname: Slusher
authors.forename: Mark
authors.initials: M
authors.lastname: Van Tuinen
mesh_terms: D017677:Age Distribution; D002648:Child; D002649:Child Abuse / Q000517:prevention & control / Q000706:statistics & numerical data*; D002669:Child Welfare; D002675:Child, Preschool; D005260:Female; D006801:Humans; D015994:Incidence; D015601:Injury Severity Score; D008297:Male; D019221:Mandatory Reporting; D008923:Missouri / Q000453:epidemiology; D011159:Population Surveillance; D011634:Public Health; D012042:Registries; D018570:Risk Assessment; D017678:Sex Distribution; D015996:Survival Rate