Abstract
Objective
Evaluate the positive predictive value of International Classification of Disease,
10th Revision, Clinical Modification (ICD-10-CM) codes in identifying young children
diagnosed with physical abuse.
Methods
We extracted 230 charts of children <24 months of age who had any emergency department,
inpatient, or ambulatory care encounters between Oct 1, 2015 and Sept 30, 2020 coded
using ICD-10-CM codes suggestive of physical abuse. Electronic health records were
reviewed to determine if physical abuse was considered during the medical encounter
and assess the level of diagnostic certainty for physical abuse. Positive predictive
value of each ICD-10-CM code was assessed.
Results
Of 230 charts with ICD-10 codes concerning for physical abuse, 209 (91%) had documentation
that a diagnosis of physical abuse was considered during an encounter. The majority
of cases, 138 (60%), were rated as definitely or likely abuse, 36 cases (16%) were
indeterminate, and 35 (15%) were likely or definitely accidental injury. Other forms
of suspected maltreatment were discussed in 16 (7%) charts and 5 (2%) had no documented
concerns for child maltreatment. The positive predictive values of the specific ICD-10
codes for encounters rated as definitely or likely abuse varied considerably, ranging
from 0.89 (0.80–0.99) for T74.12 “Adult and child abuse, neglect, and other maltreatment,
confirmed” to 0.24 (95% CI: 0.06–0.42) for Z04.72 “Encounter for examination and observation
following alleged child physical abuse.”
Conclusions
ICD-10-CM codes identify young children who experience physical abuse, but certain
codes have a higher positive predictive value than others.
Keywords
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Article info
Publication history
Published online: June 28, 2022
Accepted:
June 20,
2022
Received:
January 26,
2022
Footnotes
The authors have no conflicts of interest to disclose.
Identification
Copyright
Copyright © 2022 by Academic Pediatric Association
