Elsevier

Child Abuse & Neglect

Volume 34, Issue 11, November 2010, Pages 823-832
Child Abuse & Neglect

Monitoring child abuse and neglect at a population level: Patterns of hospital admissions for maltreatment and assault,☆☆

https://doi.org/10.1016/j.chiabu.2010.04.003Get rights and content

Abstract

Objectives

To investigate the prevalence, trends, and characteristics of maltreatment and assault related hospital admissions and deaths among children; and identify common injuries and conditions associated with these admissions using routinely collected morbidity and mortality data.

Methods

A retrospective cohort study of all children aged 0-17 years in Western Australia from 1980 to 2005 was identified from linked de-identified population level data. Annual trends in prevalence of assault and maltreatment related admissions were calculated and child characteristics were investigated using logistic regression models.

Results

Assault admissions more than doubled from 2.8 per 10,000 children in 1981 to 6.1 per 10,000 in 2005 (p < 0.0001) and maltreatment admissions rose from 0.7 per 10,000 children in 1981 to 1.3 per 10,000 in 2005 (p < 0.0001). Males aged greater than 12 years were at greater risk of an assault, while children aged less than 6 years were more likely to be at risk of maltreatment as well as those from greater disadvantaged backgrounds. Aboriginal children were more likely to be identified with assault and maltreatment compared to non-Aboriginal children. Common indicators of assault admissions included injuries of the skull and facial bones, intracranial, wrist, hand, and abdominal injuries. Children with maltreatment-related admissions were more likely to have superficial head or abdominal injuries and a high proportion had infectious and parasitic diseases, particularly intestinal infections. Many of these cases were associated with factors influencing health status, particularly socioeconomic and psychosocial circumstances.

Conclusions

There has been a steady increase in the prevalence of assault and maltreatment related admissions. Specific child characteristics and injuries associated with child assault and maltreatment-related admissions have been identified using routinely collected morbidity data and may be utilized as potential indicators for identifying and monitoring child abuse and neglect.

Practice implications

Broadening child maltreatment surveillance to children's admissions for assault and maltreatment is an important public health initiative which can be improved by the increased use of external cause codes. Health data is collected using international coding standards enhancing comparability across states and countries and has clinical implications in highlighting injuries associated with child abuse and neglect.

Introduction

Australia has reported a substantial increase of more than 50% in child protection notifications from 2002-2003 to 2006-2007 (Australian Institute of Health and Welfare, 2008). There has also been a 45% increase in the number of notifications that are substantiated as child abuse and neglect (Australian Institute of Health and Welfare, 2008). This is in contrast to trends in the United States where declines in physical and sexual abuse substantiations have been observed (Finkelhor & Jones, 2006). Policymakers and researchers predominantly rely on the number of cases reported and substantiated by child protection agencies to monitor trends. However, there are a number of limitations to using such cases for accurate monitoring. Child protection databases were not designed for the purpose of public health monitoring and each Australian state's Child Protection Agency has a different definition of a notification or substantiation of maltreatment. The increase in notifications and substantiations in Australia could also be due to the broadening of child abuse and neglect definitions used by child protection agencies (Australian Institute of Health and Welfare, 1999). These differences make both national and international comparisons an even greater challenge (O’Donnell, Scott, & Stanley, 2008). The study of child abuse and neglect needs accurate, reliable, and repeatable measures of the occurrence to ascertain trends, risk, and protective factors.

There has been a call to broaden the scope of national data collections used to investigate the burden of violence against children. In 1998, Facchin, at the WHO Meeting on Strategies for Child Protection, discussed the importance of using health indicators of child abuse rather than just legal or judicial statistics. In the 2002 “World Report on Violence and Health,” the World Health Organization (World Health Organization, 1999, World Health Organization, 2002) also stressed the importance of investigating abuse and neglect using mortality and morbidity data. These data collections have the advantage that they are routinely collected, have standard diagnostic classifications which are internationally accepted (International Classification of Disease codes, WHO), and specific coding criteria. This enhances comparisons of child abuse and neglect indicators over time and between states and countries, allowing monitoring of trends. To date, child homicide and non-accidental injuries, specifically head trauma and fractures, have been investigated (Bechtel et al., 2004, Chang et al., 2004).

The objectives of this study were to investigate the prevalence of maltreatment and assault related hospital admissions and deaths in Western Australian children and to determine what injuries and conditions were associated with these admissions using linked de-identified population level morbidity and mortality databases. The linked data also allows us to examine the characteristics of children admitted for assault and maltreatment admissions compared to the rest of the population. This study also investigated the prevalence of potential indicators of child abuse and neglect and how they are associated with coded assault and maltreatment related admissions.

Section snippets

Method

There have been three phases to this research. The first phase was a literature review of common injuries and illnesses associated with child abuse and neglect, grouped into physical, sexual abuse, and neglect. Using this review, the second phase was to seek the opinion of clinicians as to the likelihood that these identified injuries and illnesses would be associated with abuse and neglect. Three doctors from the Emergency Department and Child Protection Unit of Princess Margaret Hospital, the

Results

Of the 1,997,410 hospital admissions for 0-17 year old children over the period of 1980 to 2005, 5,321 admissions were coded with an external cause of Assault, with no maltreatment, and 1,569 admissions coded with an external cause of Maltreatment. Children could have more than 1 admission for assault and maltreatment, with 4,802 children (4.5 per 10,000 children) having an assault related admission and 1,389 children (1.3 per 10,000 children) having a maltreatment related admission. Of the

Discussion

This is the first study to assess the prevalence of child assault and maltreatment using population based hospital morbidity data. Findings highlight that there has been a steady increase in the prevalence of assault and maltreatment related admissions for children aged 0-17 years in WA from 1980 to 2005, although maltreatment has fallen from a peak in 1999. Children aged greater than 12 years were at greater risk of an assault, while children aged less than 6 years were more likely to be at

Acknowledgements

The authors acknowledge the Western Australian Data Linkage Unit who linked this data and Dr Peter Winterton, Dr Janine Spencer, and Dr Frank Willis who participated in the Paediatric Review.

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    The authors acknowledge the partnership of the Western Australian Government Departments of Health, Child Protection, Education, Disability Services, Corrective Services, and Attorney General who provided support as well as data for this project. Melissa O’Donnell was support by an Australian Postgraduate Award Industry Scholarship, provided through an Australian Research Council Linkage Project Grant (LP0455417).

    ☆☆

    This paper does not necessarily reflect the views of the government departments involved in this research.

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