Access to health services by children exposed to violence: a crosssectional study on findings from Health Care Utilization data of the Health Protection Agency (ATS) of the Metropolitan City of Milan

Background: Violence against minors is a major global public health and human rights issue. Objective: A cross-sectional study was conducted to develop tools that provide stakeholders with epidemiological data on the prevalence of minors victims of violence accessing ATS Milan health facilities. Participants and Setting: Administrative healthcare data on Emergency Department (ED) visits and hospital admissions spanning the five years from 2019 to 2023 were utilized. Methods: An algorithm was developed to detect minors subjected to violence. Specific ICD-9 diagnostic codes have been selected to identify cases. The prevalence and time trends of the phenomenon were estimated. The data were stratified by various socio-demographic characteristics and by the type and characteristics of access. In addition to these elements, integration between social and health services was explored. Results: Between 2019 and 2023, 1866 minors entered the ED with an indication of violence, for a total of 2184 admissions. The total number of hospitalizations of minors with an indication of violence is 220. Altogether, minors who had at least one access to hospitals with a diagnosis of violence are estimated to be 2029, with 1058 females (52.1%) and 972 males (47.9%). The majority of ED access and hospitalizations have involved adolescents between 14-17 years (56.4%). 6.0% of minors subjected to violence were also hosted by communities for abused minors. Conclusions: With this information, audit trails can be initiated with hospital facilities with the aim of working on the awareness and training of practitioners in light of the data for individual territorial facilities.