CDC Suspected Sex Trafficking v1

Query purpose: 

The purpose of this definition is to assist state, local, tribal, territorial, and federal public health practitioners in detecting and monitoring trends of suspected sex trafficking among emergency departments and ambulatory healthcare settings for adult and minor patients. The definition is not intended to be used for case-finding, which has the potential to unintentionally place trafficking victims at risk, but instead for monitoring trends.

How it was developed: CDC subject matter experts on sex trafficking from the Surveillance Branch of the Division of Violence Prevention worked with scientists from the CDC Division of Health Informatics and Surveillance’s National Syndromic Surveillance Program and several state health departments, to create the definition.

1. Using the current best-practices literature, the CDC team reviewed diagnosis codes (International Classification of Diseases, 10th Revision (ICD-10-CM) and Systematized Nomenclature of Medicine (SNOMED)) related to human trafficking and sexual exploitation and assessed whether the codes helped to identify suspected sex trafficking cases. The team also assessed the appropriateness of additional codes not identified in the current literature.

2. The CDC team created a list of chief complaint terms based on cases with sex trafficking diagnosis codes and common keywords related to sex trafficking in the literature. The team assessed whether each keyword should be included as an inclusion term.

3. Negation terms were determined based on common misinterpretations (e.g., traffic accident or drug trafficking), as well as careful review of chief complaint data (e.g., when providers documented that the patient used the term “sex trafficking” during a psychotic episode and the provider did not subsequently assign a sex trafficking-related diagnosis code)

4. Four participating jurisdictions from Arizona, Michigan, New Mexico, and Illinois classified visits into true and false positives and ‘unknown’ and determined the positive predictive value of the definition; jurisdictions’ validation results were analyzed and resulted in the finalized definition (described in detail below).

How it works:

The Chief Complaint Discharge Diagnosis Parsed (CCDDParsed) and Chief Complaint History fields are used to query both the discharge diagnosis codes and chief complaint free text to develop the syndrome definition.

• Inclusion based on sex trafficking or sexual exploitation discharge diagnosis codes:
  • The visit is included if it contains any of the following discharge diagnosis codes:
    • 1. T74.5- Forced sexual exploitation, confirmed
    • 2. T74.51- Adult forced sexual exploitation, confirmed
    • 3. T74.52- Child sexual exploitation, confirmed
    • 4. T74.51XS- Adult forced sexual exploitation, confirmed, sequela 
    • 5. T74.52XS- Child sexual exploitation, confirmed, sequela 
    • 6. T74.51XA- Adult forced sexual exploitation, confirmed, initial encounter
    • 7. T74.52XA- Child sexual exploitation, confirmed, initial encounter
    • 8. T74.51XD- Adult forced sexual exploitation, confirmed, subsequent encounter
    • 9. T74.52XD- Child sexual exploitation, confirmed, subsequent encounter
    • 10. T76.5- Forced sexual exploitation, suspected
    • 11. T76.51- Adult forced sexual exploitation, suspected
    • 12. T76.52- Child sexual exploitation, suspected
    • 13. T76.51XA- Adult forced sexual exploitation, suspected, initial encounter
    • 14. T76.52XA- Child sexual exploitation, suspected, initial encounter
    • 15. T76.51XD- Adult forced sexual exploitation, suspected, subsequent encounter
    • 16. T76.52XD- Child sexual exploitation, suspected, subsequent encounter
    • 17. T76.51XS- Adult forced sexual exploitation, suspected sequelae
    • 18. T76.52XS- Child sexual exploitation, suspected, sequelae
    • 19. Z04. 81: Encounter for examination and observation of victim following forced sexual exploitation
    • 20. 713834002- Victim of child sexual exploitation (finding)
  • The visit is included if it contains a discharge diagnosis code of 734998001 -Victim of human trafficking (finding)- AND the Sexual Violence v2 definition with additional bolded terms:
    • 1. (,(,^;T742^,OR,^;T762^,OR,^;Z5681^,ANDNOT,(,^;Z044[12]^,),),OR,(,^sexual ass[au]lt^,OR,^sexual ass[au][au]lt^,or,^sexual abuse^,),or,(,(,^ rape^,OR,^rape ^,),ANDNOT,(,^grape^,or,^scrape^,),),or,^sane exam^,or,^forensic nurse exam^,or,^ caart ^,or,^ sane ^,or,^sane kit^,or,^sane rn^,or,(,(,^punch^,or,^force^,),and,(,^sex^,),),),),
      • Diagnosis codes and keywords related to general human trafficking (rather than sex trafficking) were included if they were accompanied by any of the diagnosis codes or keywords from the Sexual Violence v2 definition because they indicate that the suspected trafficking was likely sexual in nature.
• Inclusion based on chief complaint terms for sex trafficking or sexual exploitation
  • The visit is included if it contains any of the following chief complaint terms:
    • 1. Sex Traf
    • 2. Sexual exploitation
    • 3. Sex Slave 
    • 4. Forced prostitution 
    • 5. Forced sex work
    • 6. Sexual servitude
  • The visit is included if it contains the chief complaint terms “human traf” or “traffick” AND the Sexual Violence v2 definition with additional bolded terms:
    • (,(,^;T742^,OR,^;T762^,OR,^;Z5681^,ANDNOT,(,^;Z044[12]^,),),OR,(,^sexual ass[au]lt^,OR,^sexual ass[au][au]lt^,or,^sexual abuse^,),or,(,(,^ rape^,OR,^rape^,),ANDNOT,(,^grape^,or,^scrape^,),),or,^sane exam^,or,^forensic nurse exam^,or,^ caart ^,or,^ sane ^,or,^sane kit^,or,^sane rn^,or,(,(,^punch^,or,^force^,),and,(,^sex^,),),),),
  • The above must exclude: 
    • 1. Traffick accident
    • 2. Car
    • 3. Vehicle
    • 4. Drug Traf
    • 5. Erratic
    • 6. Psychosis
    • 7. Psychotic
    • 8. Delusion
    • 9. Illusion
    • 10. Halluci
    • 11. Denies being a victim of sex traf
    • 12. Denies being a victim of human traf
    • 13. Denies sex traf
    • 14. Denies human traf
    • 15. Labor Traf
    • 16. Labor Exploitation
    • 17. Run into traf
    • 18. Running in and out of traf
    • 19. Worried about sex traf
    • 20. Trying to sex traf
    • 21. Hearing voice
    • 22. Manic

For consideration:

This definition has some limitations, including some false positives that remain (though infrequently), including psychosis-related episodes, other types of sexual violence, fear of but not actual sex trafficking, and history of sex trafficking with no indication of current victimization. Additional limitations include misclassification due to provider misunderstanding or underreporting by patients.