Agreement of Injury Reporting Between Primary Care Medical Record and Maternal Interview for Children Aged 0–3 Years: Implications for Research and Clinical Care

Stone, Kimberly E.; Burrell, Lori; Higman, Susan M.; McFarlane, Elizabeth; Fuddy, Loretta; Sia, Calvin; Duggan, Anne K.

doi:10.1016/j.ambp.2005.10.003

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Volume 6, Issue 2 , Pages 91-95, 1 March 2006

Agreement of Injury Reporting Between Primary Care Medical Record and Maternal Interview for Children Aged 0–3 Years: Implications for Research and Clinical Care

Presented in part at the 2004 Pediatric Academic Societies Meeting, San Francisco, Calif., May 4, 2004.

Kimberly E. Stone, MD, MPH
- Johns Hopkins University School of Medicine, Division of General Pediatrics and Adolescent Medicine, Baltimore, Md
Lori Burrell, MA
- Johns Hopkins University School of Medicine, Division of General Pediatrics and Adolescent Medicine, Baltimore, Md
Susan M. Higman, PhD
- Johns Hopkins University School of Medicine, Division of General Pediatrics and Adolescent Medicine, Baltimore, Md
Elizabeth McFarlane, MPH
- Johns Hopkins University School of Medicine, Division of General Pediatrics and Adolescent Medicine, Baltimore, Md
Loretta Fuddy, LCSW
- Hawaii Department of Health, Honolulu, Hawaii
Calvin Sia, MD
- University of Hawaii John Burns School of Medicine, Honolulu, Hawaii
Anne K. Duggan, ScD
- Johns Hopkins University School of Medicine, Division of General Pediatrics and Adolescent Medicine, Baltimore, Md
- Address correspondence to Anne Duggan, ScD, Johns Hopkins University School of Medicine, Division of General Pediatrics and Adolescent Medicine, Reed Hall, Room 204, 1620 McElderry St, Baltimore, MD 21205

Received 13 July 2004; accepted 13 October 2005.

Objective

To assess agreement of injury reporting between primary care medical record and maternal interview.

Methods

Cross-sectional study of data from a randomized controlled trial of home visiting. The setting was Hawaii’s Healthy Start Program (HSP). Subjects comprised a population-based sample of children in at-risk families with 3 years of primary care medical records and maternal interviews (n = 443). Outcome measures were percentage of children injured unintentionally and mean number of injuries per child in the first 3 years of life by primary care medical record and maternal interview.

Results

We identified 490 injuries: 48% by primary care medical record, 22% by maternal interview, and 30% in both sources. More children were reported injured by primary care medical record than maternal interview (51% vs 39%, P< .001). The mean number of injuries per child was 0.87 by primary care medical record and 0.51 by maternal interview (difference 0.36, 95% confidence interval 0.27–0.45, P< .001). Agreement between data sources was fair (κ = 0.47).

Conclusions

This study estimates that 25% of childhood injuries may not be reported in the medical record, highlighting the need for reconsideration of the use of medical records as the gold standard for unintentional injury data. Caution should be used when interpreting injury data from one source, especially from families with stressful life situations. Poor communication regarding injuries between social service, primary care and urgent care providers may contribute to decreased quality of primary care and missed opportunities for injury prevention.

Key words: medical record , parent recall , unintentional childhood injuries , wounds and injuries