Using International Classification of Diseases, 10th Edition, Codes to Estimate Abusive Head Trauma in Children

Fujiwara, Takeo; Barr, Ronald G.; Brant, Rollin; Rajabali, Fahra; Pike, Ian

doi:10.1016/j.amepre.2012.04.028

Cited by 36 publications

(32 citation statements)

References 24 publications

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“…A similar pattern holds for more general serious physical abuse hospitalizations and deaths (31). There is a clear reproducible skewing of agespecific incidence of AHT, with a peak incidence in the third month (23,28,(32)(33)(34) (Fig. 1), an age-specific pattern that holds for infant abusive fractures as well (30,35).…”

Section: Aht/sbsmentioning

confidence: 81%

“…The relative roles of acceleration/ deceleration injury; impact or blunt trauma; and secondary brain injury resulting from hypoxia, ischemia, and metabolic cascades in the clinical outcomes continue to be defined (1,(19)(20)(21)(22), but there is little debate about their potential seriousness. Estimates of incidence vary, ranging from 14 to 32 cases per 100,000 live births for infants under 1 y of age, depending on the country and whether the estimates are based on active prospective surveillance or passive surveillance (7,(23)(24)(25)(26)(27)(28). Although abusive head injury can occur in older children and even in adults (29), about 80% of cases occur before the age of 1 y (30).…”

Section: Aht/sbsmentioning

confidence: 99%

See 1 more Smart Citation

Preventing abusive head trauma resulting from a failure of normal interaction between infants and their caregivers

Barr

2012

Proc. Natl. Acad. Sci. U.S.A.

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100

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Head trauma from abuse, including shaken baby syndrome, is a devastating and potentially lethal form of infant physical abuse first recognized in the early 1970s. What has been less recognized is the role of the early increase in crying in otherwise normal infants in the first few months of life as a trigger for the abuse. In part, this is because infant crying, especially prolonged unsoothable crying, has been interpreted clinically as something wrong with the infant, the infant's caregiver, or the interactions between them. Here, we review an alternative developmental interpretation, namely, that the early increase in crying is a typical behavioral development in normal infants and usually does not reflect anything wrong or abnormal. We also review evidence indicating that this normal crying pattern is the most common trigger for abusive head trauma (AHT). Together, these findings point to a conceptualization of AHT as the consequence of a failure in an otherwise common, iterative, and developmentally normal infant-caregiver interaction. They also imply that there is a window of opportunity for prevention of AHT, and potentially other forms of infant abuse, through a public health primary universal prevention strategy aimed at changing knowledge and behaviors of caregivers and society in general concerning normal development of infants and the significance of early increased infant crying. If effective, there may be important implications for prevention of infant abuse nationally and internationally.infant development | colic | excessive crying | child maltreatment | parenting A busive head trauma (AHT), also known more commonly as shaken baby syndrome (SBS), is a devastating and potentially lethal form of infant physical abuse (1). The outcomes are grim. In recognized cases, AHT typically results in death or extremely damaging injuries. About 18-25% of babies who are shaken and hospitalized die (2-7). As many as 80% of survivors have significant lifelong brain injuries (3,8,9). Although currently under study, there are no published estimates of lifetime costs per victim specific to AHT. However, the conservative estimated lifetime costs per victim is $210,012 for nonfatal child maltreatment or $1,272,900 for a death from child maltreatment (in 2010 dollars) for a total estimated economic burdern in the US for one year of $124 billion (10). Given its relative severity compared to other forms of maltreatment, these per victim estimates are likely to underestimate the lifetime costs for AHT victims. Of course, the "costs" go far beyond financial considerations, and include the destruction of families and the failure of society's moral obligation to protect defenseless infants.Preventing child maltreatment of any kind is challenging (11) because of the lack of specific stimuli for abuse, the density and difficulties of modifying risk factors in which families of maltreated children are often embedded, and the challenges of getting appropriate supports to the families. However, the convergence of our increasing un...

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Section: Aht/sbsmentioning

confidence: 81%

Section: Aht/sbsmentioning

confidence: 99%

Preventing abusive head trauma resulting from a failure of normal interaction between infants and their caregivers

Barr

2012

Proc. Natl. Acad. Sci. U.S.A.

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100

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“…15 Because other countries have been using ICD-10-CM coding for many years, there has been interest in the use of these codes to identify child maltreatment. For example, a recent Canadian study used ICD-10-CM codes to estimate the incidence of abusive head trauma in Canada, 16 and an Australian study showed that coding of child maltreatment in Queensland hospitals was accurately done with high sensitivity and specificity. 17 Although such studies are encouraging as the United States converts to ICD-10-CM starting in October 2015, it will be important to monitor whether the transition affects the coding of children hospitalized for suspected physical abuse.…”

Section: Discussionmentioning

confidence: 99%

The Accuracy of ICD Codes: Identifying Physical Abuse in 4 Children's Hospitals

Hooft

Asnes

Livingston

et al. 2015

Academic Pediatrics

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Objective To assess the accuracy of International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM), codes in identifying cases of child physical abuse in 4 children’s hospitals. Methods We included all children evaluated by a child abuse pediatrician (CAP) for suspicion of abuse at 4 children’s hospitals from January 1, 2007, to December 31, 2010. Subjects included both patients judged to have injuries from abuse and those judged to have injuries from accidents or to have medical problems. The ICD-9-CM codes entered in the hospital discharge database for each child were compared to the decisions made by the CAPs on the likelihood of abuse. Sensitivity and specificity were calculated. Medical records for discordant cases were abstracted and reviewed to assess factors contributing to coding discrepancies. Results Of 936 cases of suspected physical abuse, 65.8% occurred in children <1 year of age. CAPs rated 32.7% as abuse, 18.2% as unknown cause, and 49.1% as accident/medical cause. Sensitivity and specificity of ICD-9-CM codes for abuse were 73.5% (95% confidence interval 68.2, 78.4), and 92.4% (95% confidence interval 90.0, 94.0), respectively. Among hospitals, sensitivity ranged from 53.8% to 83.8% and specificity from 85.4% to 100%. Analysis of discordant cases revealed variations in coding practices and physicians’ notations among hospitals that contributed to differences in sensitivity and specificity of ICD-9-CM codes in child physical abuse. Conclusions Overall, the sensitivity and specificity of ICD-9-CM codes in identifying cases of child physical abuse were relatively low, suggesting both an under- and overcounting of abuse cases.

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“…A recent study by Fujiwara and colleagues examining the incidence of AHT using ICD-10 codes in Canada demonstrated a very similar incidence to studies which have used the ICD-9-CM codes. 9 Therefore, while the transfer to ICD-10 will change the actual codes in the CDC-based definition and the AHT coding scheme will need to be carefully translated to ICD-10 equivalency, the data from Fujiwara and colleagues suggest that the change to the new coding scheme should not change whether the approach itself is accurate.…”

Section: Discussionmentioning

confidence: 99%

“…These data sources can be divided into two main categories-direct case ascertainment 2-6 and large-scale data sets, most of which use International Classification of Diseases (ICD) codes. [7][8][9][10][11][12] Direct case ascertainment is the gold standard for case identification, 13 14 but is time intensive and unlikely to be feasible or costeffective on a large scale. In contrast, ICD codes are collected as part of standard medical care and are available without charge as part of several large-scale data sets, such as the Kids' Inpatient Database (KID).…”

Section: Introductionmentioning

confidence: 99%

Assessing the accuracy of the International Classification of Diseases codes to identify abusive head trauma: a feasibility study

et al. 2013

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Objective To assess the accuracy of an International Classification of Diseases (ICD) code-based operational case definition for abusive head trauma (AHT). Methods Subjects were children <5 years of age evaluated for AHT by a hospital-based Child Protection Team (CPT) at a tertiary care paediatric hospital with a completely electronic medical record (EMR) system. Subjects were designated as non-AHT traumatic brain injury (TBI) or AHT based on whether the CPT determined that the injuries were due to AHT. The sensitivity and specificity of the ICD-based definition were calculated. Results There were 223 children evaluated for AHT: 117 AHT and 106 non-AHT TBI. The sensitivity and specificity of the ICD-based operational case definition were 92% (95% CI 85.8 to 96.2) and 96% (95% CI 92.3 to 99.7), respectively. All errors in sensitivity and three of the four specificity errors were due to coder error; one specificity error was a physician error. Conclusions In a paediatric tertiary care hospital with an EMR system, the accuracy of an ICD-based case definition for AHT was high. Additional studies are needed to assess the accuracy of this definition in all types of hospitals in which children with AHT are cared for.

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Using International Classification of Diseases, 10th Edition, Codes to Estimate Abusive Head Trauma in Children

Cited by 36 publications

References 24 publications

Preventing abusive head trauma resulting from a failure of normal interaction between infants and their caregivers

Preventing abusive head trauma resulting from a failure of normal interaction between infants and their caregivers

The Accuracy of ICD Codes: Identifying Physical Abuse in 4 Children's Hospitals

Assessing the accuracy of the International Classification of Diseases codes to identify abusive head trauma: a feasibility study

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