title: Agreement of injury reporting between primary care medical record and maternal interview for children aged 0-3 years: implications for research and clinical care.
abstract: OBJECTIVE
  To assess agreement of injury reporting between primary care medical record and maternal interview.
  
  
  METHODS
  Cross-sectional study of data from a randomized controlled trial of home visiting. The setting was Hawaii's Healthy Start Program (HSP). Subjects comprised a population-based sample of children in at-risk families with 3 years of primary care medical records and maternal interviews (n = 443). Outcome measures were percentage of children injured unintentionally and mean number of injuries per child in the first 3 years of life by primary care medical record and maternal interview.
  
  
  RESULTS
  We identified 490 injuries: 48% by primary care medical record, 22% by maternal interview, and 30% in both sources. More children were reported injured by primary care medical record than maternal interview (51% vs 39%, P< .001). The mean number of injuries per child was 0.87 by primary care medical record and 0.51 by maternal interview (difference 0.36, 95% confidence interval 0.27-0.45, P< .001). Agreement between data sources was fair (kappa = 0.47).
  
  
  CONCLUSIONS
  This study estimates that 25% of childhood injuries may not be reported in the medical record, highlighting the need for reconsideration of the use of medical records as the gold standard for unintentional injury data. Caution should be used when interpreting injury data from one source, especially from families with stressful life situations. Poor communication regarding injuries between social service, primary care and urgent care providers may contribute to decreased quality of primary care and missed opportunities for injury prevention.
authors.affiliation: Johns Hopkins University School of Medicine, Division of General Pediatrics and Adolescent Medicine, Baltimore, MD 21205, USA.
authors.forename: Kimberly E
authors.initials: KE
authors.lastname: Stone
authors.forename: Lori
authors.initials: L
authors.lastname: Burrell
authors.forename: Susan M
authors.initials: SM
authors.lastname: Higman
authors.forename: Elizabeth
authors.initials: E
authors.lastname: McFarlane
authors.forename: Loretta
authors.initials: L
authors.lastname: Fuddy
authors.forename: Calvin
authors.initials: C
authors.lastname: Sia
authors.forename: Anne K
authors.initials: AK
authors.lastname: Duggan
mesh_terms: D000061:Accidents, Home / Q000706:statistics & numerical data; D017677:Age Distribution; D002649:Child Abuse; D002662:Child Health Services; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D004522:Educational Status; D005260:Female; D006254:Hawaii / Q000453:epidemiology; D006792:House Calls; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D015601:Injury Severity Score; D008297:Male; D008499:Medical Records; D009034:Mother-Child Relations; D009035:Mothers; D011320:Primary Health Care / Q000379:methods; D011336:Probability; D012107:Research Design; D018570:Risk Assessment; D017678:Sex Distribution; D012959:Socioeconomic Factors; D014947:Wounds and Injuries / Q000175:diagnosis* / Q000453:epidemiology*