Identifying Targets to Improve Coding of Child Physical Abuse at a Pediatric Trauma Center
Identifying Targets to Improve Coding of Child Physical Abuse at a Pediatric Trauma Center
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DOI：
10.1097/jtn.0000000000000461
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发表时间：
2019-09-01
影响因子：
1
通讯作者：
Jensen, Aaron R.
中科院分区：
文献类型：
--
作者：
Durand, Maria Bautista;McLaughlin, Cory M.;Jensen, Aaron R.
儿童身体虐待是幼儿发病和死亡的主要原因。被虐待儿童的识别是具有挑战性的，并且可以影响创伤中心绩效的风险调整基准。该项目的目的是了解儿童虐待的诊断编码捕获率，并开发一种标准化的临床医生记录方法，以改善创伤登记捕获。回顾性队列研究纳入2017年所有已知或疑似虐待机制损伤的住院创伤患者。根据社会工作记录的叙述，接受儿童身体虐待法医检查的患者被分为“没有虐待”、“怀疑虐待”和“确认虐待”。我们的创伤登记被用来提取每个病人的国际疾病分类第十版（ICD-10）诊断和外因代码。然后将图表审查定义的滥用分类与使用交叉表的注册表中的编码进行比较。共有115名患者被确定为对儿童身体虐待进行了法医检查。接受法医检查的患者被分类为：40%没有虐待，37%怀疑虐待，23%在出院时确认虐待。三名法医检查阴性的患者（6%）在我们的创伤登记处被过度编码为疑似虐待。在临床证实的虐待患者中，我们的创伤登记处只有63%通过诊断代码识别，只有33%通过外因代码识别。儿童身体虐待经常被低估，出院时怀疑虐待程度的明确临床文件需要准确识别受虐待的患者。
Child physical abuse is a leading cause of morbidity and mortality in young children. Identification of abused children is challenging, and can affect risk-adjusted benchmarking of trauma center performance. The purpose of this project was to understand diagnosis coding capture rates for child abuse and develop a standardized approach to clinician documentation to improve trauma registry capture. A retrospective cohort was obtained including all admitted trauma patients with injuries from known or suspected abusive mechanism in 2017. Patients who received forensic workup for child physical abuse were classified as "no abuse," "suspected abuse," and "confirmed abuse" using narratives from social work notes. Our trauma registry was used to abstract International Classification of Diseases, Tenth Revision (ICD-10) diagnostic and external cause codes for each patient. Abuse classifications defined by chart review were then compared with coding in the registry using crosstabs. A total of 115 patients were identified as having a forensic workup for child physical abuse. Patients who underwent forensic workup were classified as: 40% no abuse, 37% suspected abuse, and 23% confirmed abuse at the time of discharge. Three patients (6%) with a negative forensic workup were overcoded as suspected abuse in our trauma registry. Among patients with clinically confirmed abuse, our trauma registry identified only 63% by diagnostic codes and only 33% by external cause codes. Child physical abuse is frequently undercoded, and clear clinical documentation of the level of suspicion of abuse at discharge is needed to accurately identify abused patients.