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Validity of Diagnostic and Procedure Codes in Administrative Data to Identify Pediatric Physical Abuse

Erika Obikane1, Tomoko Nishino1, Harumi Sonehara2

  • 1Department of Social Medicine, National Center for Child Health and Development, Setagaya, Tokyo, Japan.

Pediatrics International : Official Journal of the Japan Pediatric Society
|May 26, 2026
PubMed

Insights

International Classification of Diseases, 10th Revision (ICD-10) codes are unreliable for identifying child physical abuse. Combining diagnostic codes with specific medical procedures can improve detection for future surveillance.

Area of Science:

  • Pediatric Health
  • Public Health Surveillance
  • Medical Informatics

Background:

  • Many countries lack robust systems for tracking child abuse using diagnostic codes.
  • This study addresses the inadequacy of current diagnostic coding for child abuse identification.

Purpose of the Study:

  • To evaluate the validity of International Classification of Diseases, 10th Revision (ICD-10) codes for identifying child physical abuse.
  • To develop algorithms for detecting physical abuse in administrative data.

Main Methods:

  • Analysis of hospitalized injury cases in children under 10 years in Japan (April 2013-March 2023).
  • Utilized child protection team records as the reference standard.
  • Employed machine learning to assess diagnostic, procedure, and medication codes.

Main Results:

  • Only one of 53 physical abuse cases used an abuse-specific ICD-10 code, showing low reliability.
  • Combining X-ray and fundus examinations yielded high sensitivity and specificity for detecting abuse in children under 10 and under 6.
  • Machine learning models (Lasso, random forest, B-CRT) provided consistent findings.

Conclusions:

  • ICD-10 codes alone are insufficient for accurate identification of child physical abuse.
  • Integrating specific medical procedures with diagnostic codes can enhance case identification for epidemiological surveillance.
Abstract

Keywords:
ICD‐10administrative claims datachild abusephysical abusevalidation study

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