title: Variation in recorded child maltreatment concerns in UK primary care records: a cohort study using The Health Improvement Network (THIN) database.
abstract: OBJECTIVE
  To determine variation over time and between practices in recording of concerns related to abuse and neglect (maltreatment) in children's primary care records.
  
  
  METHODS
  Retrospective cohort study using a United Kingdom representative primary care database.
  
  
  METHODS
  448 General Practices.
  
  
  METHODS
  In total 1,548, 972 children (<18 y) registered between 1995 and 2010.
  
  
  METHODS
  Change in annual incidence of one or more maltreatment-related codes per child year of registration. Variation between general practices measured as the proportion of registered children with one or more maltreatment-related codes during 3 years (2008-2010).
  
  
  RESULTS
  From 1995-2010, annual incidence rates of any coded maltreatment-related concerns rose by 10.8% each year (95% confidence interval 10.5, 11.2; adjusted for sex, age and deprivation). In 2010 the rate was 9.5 per 1000 child years (95%CI: 9.3, 9.8), equivalent to a prevalence of 0.8% of all registered children in 2010. Across all practices, the median prevalence of children with any maltreatment-related codes in three years (2008 to 2010) was 0.9% (range 0%-13.4%; 11 practices (2.5%) had zero children with relevant codes in the same period). Once we accounted for sex, age, and deprivation, the prevalence for each practice was within two standard errors of the grand mean.
  
  
  CONCLUSIONS
  General Practitioners (GPs) are far from disengaged from safeguarding children; they are consistently and increasingly recording maltreatment concerns. As these results are likely to underestimate the burden of maltreatment known to primary care, there is much scope for increasing recording in primary care records with implications for resources to respond to concerns about maltreatment. Interventions and policies should build on this evidence that the average GP in the UK is engaged in child safeguarding activity.
authors.affiliation: MRC (Medical Research Council)-Centre of Epidemiology for Child Health, University College London (UCL)-Institute of Child Health, London, United Kingdom.
authors.forename: Jenny
authors.initials: J
authors.lastname: Woodman
authors.forename: Nick
authors.initials: N
authors.lastname: Freemantle
authors.forename: Janice
authors.initials: J
authors.lastname: Allister
authors.forename: Simon
authors.initials: S
authors.lastname: de Lusignan
authors.forename: Ruth
authors.initials: R
authors.lastname: Gilbert
authors.forename: Irene
authors.initials: I
authors.lastname: Petersen
mesh_terms: D000293:Adolescent; D002648:Child; D002649:Child Abuse / Q000266:history / Q000706:statistics & numerical data*; D002675:Child, Preschool; D015331:Cohort Studies; D016208:Databases, Factual; D005260:Female; D058006:General Practice; D049673:History, 20th Century; D049674:History, 21st Century; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D015995:Prevalence; D011320:Primary Health Care; D006113:United Kingdom / Q000453:epidemiology