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Variation in recording of child maltreatment in administrative records of hospital admissions for injury in England, 1997–2009
  1. Arturo González-Izquierdo1,
  2. Jenny Woodman1,
  3. Lynn Copley2,
  4. Jan van der Meulen2,3,
  5. Marian Brandon4,
  6. Deborah Hodes5,6,
  7. Fiona Lecky7,
  8. Ruth Gilbert1
  1. 1MRC Centre of Epidemiology for Child Health, UCL Institute of Child Health, London, UK
  2. 2Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, UK
  3. 3Health Services Research Unit, London School of Hygiene and Tropical Medicine, London, UK
  4. 4School of Social Work and Psychology, University of East Anglia, Norwich, Norfolk, UK
  5. 5Camden Primary Care Trust, London, UK
  6. 6University College London Hospital, London, UK
  7. 7Trauma Audit and Research Network, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
  1. Correspondence to Ruth Gilbert, MRC Centre of Epidemiology for Child Health, UCL Institute of Child Health, London WC1N 1EH, UK; r.gilbert{at}


Background Information on variation in the recording of child maltreatment in administrative healthcare data can help to improve recognition and ensure that services are able to respond appropriately.

Objective To examine variation in the recording of child maltreatment and related diagnoses.

Design Cross-sectional analyses of administrative healthcare records (Hospital Episode Statistics).

Setting and participants Acute injury admissions to the National Health Service in England of children under 5 years of age (1997–2009).

Outcome measure Annual incidence of admission for injury recorded by International Classifications of Diseases 10 codes for maltreatment syndrome (child abuse or neglect) or maltreatment-related features (assault, undetermined cause or adverse social circumstances). Proportion of all admissions for injury coded for maltreatment syndrome or maltreatment-related features.

Results From 1997 to 2009, the annual incidence of injury admissions coded for maltreatment syndrome declined in infants and in 1–3-year-old children while admissions coded for maltreatment-related features increased in all age groups. The combined incidence of these categories remained stable. Overall, 2.6% of injury admissions in infants, and 0.4–0.6% in older age groups, had maltreatment syndrome recorded. This prevalence more than doubled when maltreatment-related codes were added (6.4% in infants, 1.5–2.1% in older age groups).

Conclusion Despite a shift from maltreatment syndrome to codes for maltreatment-related features, the overall burden has remained stable. In combination, the cluster of codes related to maltreatment identify children likely to meet thresholds for suspecting or considering maltreatment and taking further action, as recommended in recent National Institute of Health and Clinical Excellence guidance, and indicate a considerable burden to which hospitals should respond.

Statistics from


  • Funding The study was funded by the Medical Directorate of the Department of Health for England. This work was undertaken at Great Ormond Street Hospital/University College London, Institute of Child Health which received a proportion of funding from the Department of Health's National Institute of Health Research (‘Biomedical Research Centres’ funding). The Medical Research Council provides funds for the MRC Centre of Epidemiology for Child Health.

  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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