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Determining Intentionality of Pediatric Firearm Injuries by International Classification of Disease Code
Katie A Donnelly1, Gia M Badolato, Monika K Goyal
1From the Children's National Hospital, George Washington University, Washington, DC.
Insights
International Classification of Disease (ICD) codes for pediatric firearm injuries lack accuracy in determining intent. Chart review reveals discrepancies, suggesting ICD codes need revision for better validity.
Area of Science:
- Pediatric Trauma and Injury Research
- Public Health Surveillance
- Medical Coding Accuracy
Background:
- Firearm injuries represent a significant cause of severe injury and mortality in children.
- The reliability of International Classification of Disease (ICD) codes for classifying the intent behind firearm injuries is not well-established.
Purpose of the Study:
- To evaluate the accuracy of documented ICD codes in determining the intent of pediatric firearm injuries.
- To compare ICD code classifications with detailed chart review findings.
Main Methods:
- A retrospective cohort study analyzed 122 pediatric firearm injury cases (<= 18 years) from 2006-2017 at a pediatric trauma center.
- Agreement between ICD codes and injury intent (derived from medical record review) was assessed using Cohen κ.
- Sensitivity analyses were conducted by classifying 'mistaken target' injuries as either accidental or assault.
Main Results:
- ICD codes most frequently assigned 'assault' (65.6%) as the intent.
- Medical record review identified 'mistaken target' as the most common intent.
- When 'mistaken target' was coded as accidental, 72.9% of injuries were classified as accidental; when coded as assault, 79.5% were classified as assault.
- Cohen κ values of 0.15 (accidental) and 0.30 (assault) indicated poor agreement.
Conclusions:
- Current ICD codes inadequately capture the intent of pediatric firearm injuries.
- Revisions to ICD codes, specifically incorporating 'mistaken target' as a distinct category, are recommended to enhance coding validity.
Objective:
Firearm injuries are a leading cause of serious injury and death in childhood. The accuracy of International Classification of Disease (ICD) codes to assign intent is unclear. The objective of this study was to assess the validity of documented ICD codes for firearm injury intent compared with chart review.
Methods:
We performed a retrospective cohort study of children (<= 18 years) presenting to a tertiary care level 1 pediatric trauma center with firearm injuries between 2006 and 2017. We compared agreement between ICD codes and intent of injury determined by medical record review using Cohen κ. Intent for medical record review was assigned via the injury spectrum of intentionality (suicide attempt, accidental firing, mistaken target, firearm assault and unknown). For comparison with ICD codes, all medical record review cases marked as mistaken target were classified as accidental. A sensitivity analysis was then performed, coding all mistaken targets as assault.
Results:
There were 122 cases identified over the study period. The most common intent by ICD code was assault (n = 80, 65.6%). Medical record review categorized most injuries as mistaken targets. When mistaken target was categorized as accidental, most firearm injuries were coded as accidental (n = 89, 72.9%) Similar results were seen when mistaken target was categorized as assault, most injuries were categorized as assault (n = 79, 79.5%) Cohen κ was 0.15 when mistaken targets were categorized as accident and 0.30 when categorized as assault.
Conclusions:
The ICD codes do not fully describe the intent of firearm injury. Revising ICD codes to account for mistaken targets could help to improve the validity of ICD codes for intent.
