Background: Adverse childhood experiences (ACEs) are linked to negative health
outcomes in adulthood. Poor engagement with services may in part mediate the
association between adverse outcomes and ACEs. While appointment recording is
comprehensive, it is not yet known if or how ACEs are recorded in the GP clinical
record.

Aim: To investigate recording of ACEs in the GP clinical record and assess associations
between available ACEs related Read codes and missed appointments.
Design and Setting Retrospective cohort study of 824,374 anonymised GP patient
records. Nationally representative sample of 136 Scottish GP practice data, 2013-
2016.

Method: Read codes were mapped onto ACE questionnaire and wider ACE-related
domains. Natural language processing (NLP) was used to augment capture of nonRead-coded ACEs. Frequency counts and proportions of mapped codes, and
associations of these with defined levels of missing GP appointments, are reported.

Results: 0.4% of patients had a record of any code that mapped onto the ACE
questionnaire, contrasting with survey reported rates of 47% in population samples.
This increased only modestly by including inferred ACEs that related to safeguarding
children concerns, wider aspects of ACEs and adult consequences of ACEs.
Augmentation via NLP did not substantially increase capture. Despite poor recording,
there was an association between ever having an ACE code recorded and higher rates
of missing GP appointments.

Conclusion: GP practices would require substantial support to implement the
recording of ACEs in the patient record. This paper adds to the evidence that
patients who often miss appointments are more likely to be socially vulnerable.