Aims To determine the prevalence of codes related to child maltreatment in hospital administrative records of children with head injury or fracture.
Methods We examined NHS hospital episode statistics for children aged 1 week to 5 years admitted in England 1997–2009) with an intracranial injury (ICI), uncomplicated head injury (no ICI or skull fracture) or a fractured long bone. We determined the prevalence of any maltreatment-related code given type of injury and age group (clinical perspective), and the proportion of any admissions for ICI, uncomplicated head injury or long bone fracture that had a maltreatment-related code (public health perspective).
Results The prevalence of maltreatment-related injury was highest for infants under 6 months with ICI (31%) or long bone fracture (29%) and declined with age. The large majority of maltreatment-related injury admissions occurred in low risk children aged 1 to 5 years with uncomplicated head injury (table 1).
Conclusions Under-recording of child maltreatment in hospital administrative data may partly explain the reduced prevalence of maltreatment-related codes with increasing age and is likely to be most marked for uncomplicated head injuries. Clinicians need to take both a clinical and public health perspective. Response to high risk injuries such as ICI and long bone fracture in young infants needs to be combined with a public health approach that recognises that most children with maltreatment-related injury have low risk injuries.