Estimating the Prevalence of Child Abuse and Neglect Among Adolescents in Primary Care Through Diagnoses Codes and Free-Text EHR Clinical Notes.
Rachel Y Lee, Aviv Y Landau, Paul M Heider and 4 others
PMID 39580745WHAT IT FOUND
Adolescent clinical notes contained more suspected or confirmed child abuse and neglect than diagnosis codes: 294 patients versus 111.
Primary care providers should review free-text notes, not rely only on coded diagnoses.
Key findings
01In records from 8,157 adolescents, the note search found child abuse and neglect information for 294 patients, while ICD-10 codes found 111 patients.
02Of the 294 patients found by the note search, 253 had no corresponding ICD-10 code.
03The note search's positive findings were 96% correct when checked on 100 notes labeled positive.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study used records from a single urban primary care network, and most patients were Hispanic, so results may not apply elsewhere. It was a retrospective chart review, so it measured what was documented, not patient outcomes. The note search depended on clinicians writing enough detail; different documentation styles could miss or mislabel cases. The pattern-matching method may miss subtle wording and may also flag text that is not abuse-related. Four patients lacked demographic information.
Declared interests
The authors declared no conflicts of interest.
The easy way to misread this
Do not conclude that automated note screening is proven to improve adolescent care or should be adopted as a clinical tool. This was a retrospective chart review in a single primary care network, and it did not test patient outcomes or workflow implementation.