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Original Investigation
August 3, 2020

Hospital Injury Encounters of Children Identified by a Predictive Risk Model for Screening Child Maltreatment Referrals: Evidence From the Allegheny Family Screening Tool

Author Affiliations
  • 1Auckland University of Technology, Auckland, New Zealand
  • 2University of Southern California, Los Angeles
  • 3Carnegie Mellon University, Pittsburgh, Pennsylvania
  • 4Children’s Hospital of Pittsburgh, UPMC, Pittsburgh, Pennsylvania
JAMA Pediatr. Published online August 3, 2020. doi:10.1001/jamapediatrics.2020.2770
Key Points

Question  Do children reported as having experienced alleged maltreatment and classified by a predictive risk model to be at high risk of foster care placement show an increased risk of emergency department and inpatient hospitalizations for injuries?

Findings  In this cohort study, children who scored in the highest 5% risk group by the predictive risk model were more likely to have a medical encounter for an injury during the follow-up period than low-risk children (ie, those in the bottom 50% of risk).

Meaning  Our findings support that the Allegheny model, trained to predict foster care placement, was sensitive to medical encounters for injuries.

Abstract

Importance  Nearly 6 million children are reported as allegedly experiencing abuse or neglect in the US annually. Child protection agencies are increasingly turning to automated predictive risk models (PRMs) that mine information found in routinely collected administrative data and estimate a likelihood that an individual will experience some future adverse outcome.

Objective  To test if a PRM used at the time of referral for alleged maltreatment, which automatically generates a risk stratification score indicating the relative likelihood of future foster care placement, is also predictive of injury hospitalization data.

Design, Setting, and Participants  This retrospective cohort study based on a probabilistic association between child protection and hospital encounter data was conducted in Allegheny County, Pennsylvania, and at Children’s Hospital of Pittsburgh (Pittsburgh, Pennsylvania). Participants included children referred for alleged neglect or abuse in Allegheny County between April 1, 2010, and May 4, 2016.

Exposures  Risk score generated from the PRM.

Main Outcomes and Measures  Medical encounters (emergency department and inpatient hospitalizations) for any-cause injuries, suicide or self-inflicted harm injuries, and abuse injuries between 2002 and 2015 for children classified by the PRM to different risk levels at the time of a maltreatment referral. Cancer encounters were used as a placebo test.

Results  Of 47 305 participants, 23 601 (49.9%) were girls, the mean (SD) age at referral was 8 (5.7) years, 28 211 (59.6%) were black, and 19 094 (40.4%) were nonblack. Children who scored in the highest 5% risk group by the PRM were more likely to have a medical encounter for an injury during the follow-up period than low-risk children (ie, those in the bottom 50% of risk). Specifically, among children referred for maltreatment and classified as highest risk, the rate of experiencing an any-cause injury encounter was 14.5 (95% CI, 13.1-15.9) per 100 compared with children who scored as low risk who had an any-cause injury encounter rate of 4.9 (95% CI, 4.7-5.2) per 100. For abuse-associated injury encounters, the rate for high-risk children was 2.0 (95% CI, 1.5-2.6) per 100 and that of low-risk children was 0.2 (95% CI, 0.2-0.3) per 100; for suicide and self-harm, the high-risk encounter rate was 1.0 (95% CI, 0.6-1.4) per 100 and that of low-risk children was 0.1 (95% CI, 0.1-0.1) per 100. There was no association between risk scores and cancer encounters.

Conclusions and Relevance  Findings confirm that children reported for having experienced alleged maltreatment and classified by a PRM tool to be at high risk of foster care placement are also at increased risk of emergency department and in-patient hospitalizations for injuries.

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