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CDC Suspected Child Abuse and Neglect v1

Why the syndrome was created:

The purpose of the suspected child abuse and neglect (sCAN) syndromic surveillance query is to monitor trends in childhood abuse and neglect in emergency departments and ambulatory healthcare settings. For the purposes of this syndrome, suspected child abuse or neglect are categorized as visits related to suspected or confirmed physical, sexual, or emotional abuse; and physical or emotional neglect as perpetrated by a parent or other caregiver. Caregivers included in the definition were persons, who at the time of the maltreatment, were in a permanent (primary caregiver) or temporary (substitute caregiver) custodial role. Examples include biological, adoptive, step-, or foster parents; parents or caregivers’ intimate partners; teachers; babysitters; and nanny. As child abuse is typically defined as an act of abuse or neglect by a parent or caregiver, acts of violence perpetrated by peers, classmates, siblings, or the victim’s intimate partner were excluded from the sCAN query. 

The query was developed as a collaboration between National Syndromic Surveillance Program (NSSP), scientists in the Center for Disease Control and Prevention’s (CDC) Division of Violence Prevention, and local and state health departments. International Classification of Diseases, 9th Revision, Clinical Modification codes (ICD-9-CM), International Classification of Diseases, 10th Revision, Clinical Modification codes (ICD-10-CM), Systematized Nomenclature of Medicine (SNOMED) codes, and chief complaint keywords were included for conditions related to suspected or confirmed child abuse and neglect and for identification of perpetrators. The query is age-limited to children under the age of 18 years to capture child abuse or neglect-related visits. To maintain specificity of the query, certain chief complaint terms (e.g., “rape”, “assault”, “SAFE exam”, “suspected sexual”, “alleged sexual”, etc.,) are only included in the search when paired with parent or other caregiver perpetrator terms (identified by an ICD-9 code, ICD-10 code, SNOMED code, or keyword) to exclude potential cases of peer or intimate partner violence. ICD-10 codes Z04.42 (“Suspected child sexual abuse, ruled out”) and Z04.72 (“Suspected physical abuse, ruled out”) are included in the sCAN definition. Although official CMS documentation recommends that these codes be used when suspected CAN has been ruled out, this code is sometimes used by coders to denote cases where suspected CAN has not been ruled out. In order to detect as many suspected CAN cases as possible, we opted to include these codes. 

The query has been evaluated using national and local data from several states and counties. The query has been added to NSSP BioSense Platform Electronic Surveillance System for the Early Notification of Community-based Epidemics (ESSENCE) as a Chief Complaint and Discharge Diagnosis (CC and DD) Category called CDC Suspected Child Abuse and Neglect v1. Future revision of the definition is possible as trends emerge, and feedback is provided. 

Data sources the syndrome was used on (e.g., emergency room, EMS, air quality):

Emergency room

Fields used to query the data (e.g., chief complain, discharge diagnosis, triage notes):

Chief complaint, discharge diagnosis

Supporting documents:

CDC Suspected Child Abuse and Neglect v1


Elizabeth Swedo (


Syndrome Definition

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