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

Area of Science:

• Medical Informatics
• Pediatric Medicine
• Forensic Medicine

Background:

• Accurate coding of child abuse is crucial for public health surveillance and resource allocation.
• The International Classification of Diseases, Clinical Modification (ICD-10-CM) is widely used for disease and injury coding.
• The diagnostic accuracy of ICD-10-CM codes for physical child abuse has not been extensively evaluated.

Purpose of the Study:

• To evaluate the accuracy of ICD-10-CM coding for physical child abuse.
• To compare coding accuracy between inpatient and outpatient settings.
• To determine the sensitivity, specificity, and predictive values of ICD-10-CM codes against a multidisciplinary child protection team's determination.

Main Methods:

• Retrospective study of 312 patients evaluated for physical abuse between 2016-2017.
• Used multidisciplinary child protection team (MCPT) abuse determination as the reference standard.
• Calculated sensitivity, specificity, predictive values, and diagnostic odds ratios (OR) for ICD-10-CM codes, stratified by admission status.

Main Results:

• Inpatient coding sensitivity was 55.6% and specificity was 78.6% (diagnostic OR=4.58).
• Outpatient coding sensitivity was 22.2% and specificity was 86.3% (diagnostic OR=1.80).
• ICD-10-CM coding demonstrated lower sensitivity in outpatients compared to inpatients.

Conclusions:

• ICD-10-CM coding alone significantly underestimates the occurrence of physical child abuse.
• Reliance on ICD-10-CM coded data for surveillance purposes may lead to underestimation of child abuse incidence.
• Improved coding practices and supplementary data sources are needed for accurate child abuse surveillance.