Accuracy of ICD-10-CM coding for physical child abuse in a paediatric level I trauma centre

Abstract

This retrospective study examined the accuracy of the International Classification of Diseases, Clinical Modification (ICD-10-CM) coding for physical child abuse among patients less than 18 years of age who were evaluated due to concern for physical abuse by a multidisciplinary child protection team (MCPT) during 2016–2017 (N=312) in a paediatric level I trauma centre. Sensitivity, specificity, predictive values and diagnostic OR for ICD-10-CM coding were calculated and stratified by admission status, using as a reference standard the abuse determination of the MCPT recorded in a hospital registry. Among inpatients, child physical abuse coding sensitivity was 55.6% (95% CI 41.4% to 69.1%) and specificity was 78.6% (95% CI 59.0% to 91.7%), with diagnostic OR of 4.58 (95% CI 1.64 to 12.70). Among outpatients, sensitivity was 22.2% (95% CI 15.5% to 30.2%) and specificity was 86.3% (95% CI 77.7% to 92.5%), with diagnostic OR of 1.80 (95% CI 0.89 to 3.64). Use of ICD-10-CM coded data sets alone for surveillance may significantly underestimate the occurrence of physical child abuse.

Child maltreatment-related children's emergency department visits before and during the COVID-19 pandemic in Connecticut

“…First, our novel strategy to identify cases by ICD-10-CM codes, chief concerns, and provider notes, as well as examining child protection reports and consultations by child abuse evaluation teams, was more comprehensive than previous studies, which only used ICD-10-CM codes to examine rates of child maltreatment before and during the pandemic ( Kaiser et al, 2021 ; Swedo, 2020 ). We found that our search strategy approximately doubled our case identification compared to using ICD-10-CM codes alone, similar to previous work ( Hughes Garza et al, 2021 ). By considering state CPS reporting, we were able to demonstrate a corresponding increase in the proportion of in CPS reports related to neglect along with increased ED visits for neglect during the first months of the pandemic.…”

“…As acknowledged by the authors of these studies, the use of only ICD codes for detection likely underestimates the rate of maltreatment-related ED visits, given that ICD codes for child maltreatment are more specific than sensitive. ( Hughes Garza, Piper, Barczyk, Pérez, & Lawson, 2021 ) Furthermore, wide variability in state policies during the pandemic limits the ability of national data sets to describe the relationship between state policies and healthcare utilization. Lastly, these studies only examined physical abuse rates and did not assess whether rates of ED visits for sexual abuse and neglect were similarly affected by policies implemented at the state level.…”

Incidence of child abuse with subdural hemorrhage during the first year of the COVID-19 pandemic: a nationwide study in France

“…In contrast to our present results, Sidpra et al’s single-center study found a 1493% increase in hospital admissions for AHT in 2020, relative to the three previous years [ 13 ]. Several other studies have evidenced increases in the number of hospital admissions for child abuse [ 14 , 15 ]. The COVID-19 crisis has accentuated tensions between family members; due to confinement and other restrictions, exasperated and/or exhausted adults might be more likely to shake and injure a crying infant.…”

“…Furthermore, the month-on-month differences between the 2020 COVID-19 group and the 2018 and 2019 groups might have been due to chance. Lastly, the diagnosis of AHT is complex; this might explain the contradictory literature data [ 14 , 21 , 22 ].…”

Increased severity of abusive head trauma during the first year of the COVID-19 pandemic

“…ICD diagnosis codes have been shown to both under and overcount abuse cases ( Ellingson, Leventhal, & Weiss, 2008 ; Hooft et al, 2015 ). Moreover, in the U.S. the 2015 transition to ICD-10 and the introduction of diagnosis codes for suspected and confirmed abuse led to volatile changes in coding practices and may have decreased the sensitivity and specificity of ICD-10 codes as compared to ICD-9 diagnosis codes ( Hughes Garza, Piper, Barczyk, Pérez, & Lawson, 2021 ). The use of a prospectively collected database of children evaluated and diagnosed by a Child Protection Team, as was used in this study, allows for providing case specific information and decreases the risk of including miscategorized patients ( Berger, Parks, Fromkin, Rubin, & Pecora, 2015 ).…”