title: Assessing the concordance of health and child protection data for 'maltreated' and 'unintentionally injured' children.
abstract: OBJECTIVE
  To quantify the concordance of hospital child maltreatment data with child protection service (CPS) records, and identify factors associated with linkage.
  
  
  METHODS
  Multivariable logistic regression analysis was conducted following retrospective medical record review and database linkage of 884 child records from 20 hospitals and the CPS in Queensland, Australia.
  
  
  RESULTS
  Nearly all children with hospital assigned maltreatment codes (93.1%) had a CPS record. Of these, 85.1% had a recent notification. 29% of the linked maltreatment group (n=113) were not known to the CPS prior to the hospital presentation. Almost one third of children with unintentional injury hospital codes were known to the CPS. Just over 24% of the linked unintentional injury group (n=34) were not known to the CPS prior to the hospital presentation but became known during or after discharge from hospital. These estimates are higher than the 2006/2007 annual rate of 2.39% of children being notified to the CPS. Rural children were more likely to link to the CPS, and children were over three times more likely to link if the index injury documentation included additional diagnoses or factors affecting their health.
  
  
  CONCLUSIONS
  The system for referring maltreatment cases to the CPS is generally efficient, although up to 1 in 15 children had codes for maltreatment but could not be linked to CPS data. The high proportion of children with unintentional injury codes who linked to CPS suggests that clinicians and hospital-based child protection staff should be supported by further education and training to ensure children at risk are being detected by the child protection system.
authors.affiliation: Faculty of Health, National Centre for Health Information Research and Training, School of Public Health, Queensland University of Technology, Australia. k.mckenzie@qut.edu.au
authors.forename: Kirsten
authors.initials: K
authors.lastname: McKenzie
authors.forename: Debbie
authors.initials: D
authors.lastname: Scott
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Fraser
authors.forename: Michael P
authors.initials: MP
authors.lastname: Dunne
mesh_terms: D000293:Adolescent; D002648:Child; D002649:Child Abuse / Q000175:diagnosis / Q000517:prevention & control / Q000706:statistics & numerical data*; D002669:Child Welfare / Q000706:statistics & numerical data*; D002675:Child, Preschool; D003625:Data Collection / Q000592:standards*; D019033:Delivery of Health Care, Integrated / Q000592:standards; D005260:Female; D006801:Humans; D007223:Infant; D016015:Logistic Models; D008297:Male; D019221:Mandatory Reporting; D008499:Medical Records / Q000706:statistics & numerical data*; D015999:Multivariate Analysis; D011793:Queensland; D014947:Wounds and Injuries / Q000145:classification