Using maltreatment to predict hospitalization for injury rate


Not every child has a safe home. An investigation examines whether children with alleged maltreatment and who are at high risk of foster care placement have an increased risk of hospitalization for injuries.

In an ideal world every child would live in home with a family who loves them and that child would never have to fear maltreatment or removal from the home. Unfortunately, we don’t live in that world and some children do have those worries. An investigation in JAMA Pediatrics looks at whether children who have allegedly been maltreated and categorized at high-risk of being placed in foster care by a predictive risk model had an increased risk of emergency department and inpatient hospitalizations for injuries.1

Investigators ran a retrospective cohort study that was based on a probabilistic link between hospital encounter data and child protection. The study was conducted in Allegheny County, Pennsylvania, and at the Children’s Hospital of Pittsburgh. The study’s participants were children who had been referred for either alleged neglect or alleged abuse in Allegheny County between April 2010 and May 2016.

There were 47,305 participants and 23,601 of them were girls. The average age at referral was 8 years and 28,211 of the participants were Black. Children who were rated as the highest 5% risk group by the predictive risk group were found to be more likely to have a medical encounter for treatment of an injury in the follow-up period that children who were in the low-risk group, which was the bottom 50% of risk. Among the children who were referred for maltreatment and who were classified as being at highest risk, the rate of experiencing an any-cause injury encounter was 14.5 per 1000. In comparison, the children at lowest risk had an any-case injury encounter rate was 4.9 per 1000. When the cause of injury was reduced to abuse-associated injury, the high-risk children had a rate of 2.0 per 1000 and the low-risk children had a rate of 0.2 per 1000. No link was found between risk scores and cancer outcomes.

The researchers concluded that children who are at high risk of foster care placement and who have also reported alleged mistreatment were at an increased risk of both emergency department utilization and in-patient hospitalization for injuries.


1. Vaithianathan R, Putnam-Hornstein E, Chouldechova A, Benavides-Prado D, Berger R. Hospital injury encounters of children identified by a predictive risk model for screening child maltreatment referrals. JAMA Pediatr. August 3, 2020. Epub ahead of print. doi:10.1001/jamapediatrics.2020.2770

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