(710) Describing Child Protective Services Referral Data From a Children’s Hospital

Introduction: A reporter’s implicit biases influence referral to child protective services (CPS) for suspected abuse or neglect. Over- and under-reporting have ramifications for patients and system resources. Our objective is to identify factors associated with CPS referral. The project’s specific aim is to describe incidence, demographics, and admission diagnoses among CPS-referred patients. We hypothesize that diagnoses of physical abuse will be most common among matched patients.

Methods: This retrospective cohort study includes all patients referred to CPS from the emergency department at Golisano Children’s Hospital (GCH) from 1/1/15–1/1/23. We deterministically linked CPS referral subjects to patients in our electronic health record by matching names, birthdates, and addresses. The primary outcomes are diagnosis codes assigned to CPS referred patients. We extracted associated ICD10 codes at admission and billing and coalesced them into clinically meaningful groups via Clinical Classifications Software Refined categories. Secondarily we report descriptive statistics on patient referrals and demographics including age, race, ethnicity, and zip code.

Results: GCH referred a total of 2,537 patients to CPS. There was a significant difference in number of referrals by year (χ2 37.4, p< 0.05), with an increasing trend over time. We accurately matched 1760 (69.4%) subjects with 30.6% unmatched. The top 3 most frequent diagnoses were Burns (10.4%), Maltreatment/Abuse (9.2%), and Superficial Injury/Contusion (7.1%). A total of 662 (44.4%) patients had at least one of these diagnoses. The median age of referred patients was 4.1yr (IQR 10.4yr). Physical abuse diagnoses were most frequently assigned to patients referred directly from the emergency department.

Conclusions: In this study we matched CPS-reported subjects to hospitalized patients, described this population, and identified the most frequent admission and billing diagnoses. These results highlight the incidence of abuse and trauma diagnoses assigned to patients referred to CPS. Ongoing work includes identifying all admitted patients with these representative diagnoses, and describing the association of CPS referral status with patient features including race, ethnicity, and socioeconomic status.