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ICD-10-CM Codes for the Identification of Abusive Head Trauma in Administrative Datasets

  • Emily C.B. Brown
    Correspondence
    Address correspondence to Emily C.B. Brown, MD, MS, Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA 98105
    Affiliations
    University of Washington School of Medicine, Department of Pediatrics, Seattle Children's Hospital (ECB Brown and CE Crumm), Seattle, Wash
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  • Caitlin E. Crumm
    Affiliations
    University of Washington School of Medicine, Department of Pediatrics, Seattle Children's Hospital (ECB Brown and CE Crumm), Seattle, Wash
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  • Kristin Garton Crichton
    Affiliations
    Ohio State University, College of Medicine, Department of Pediatrics, Nationwide Children's Hospital (KG Crichton), Columbus
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  • Author Footnotes
    1 Present/permanent addresses: University of Washington School of Medicine, Department of Pediatrics, Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA 98105.
    Jessica Panks
    Footnotes
    1 Present/permanent addresses: University of Washington School of Medicine, Department of Pediatrics, Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA 98105.
    Affiliations
    University of Colorado School of Medicine, Department of Pediatrics, Children's Hospital Colorado (J Panks), Aurora
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  • Author Footnotes
    2 Present/permanent addresses: Brooke Army Medical Center, Uniformed Services University of the Health Sciences, 3551 Roger Brooke Dr, Fort Sam Houston, TX 78234.
    Alex Hatch
    Footnotes
    2 Present/permanent addresses: Brooke Army Medical Center, Uniformed Services University of the Health Sciences, 3551 Roger Brooke Dr, Fort Sam Houston, TX 78234.
    Affiliations
    University of Utah School of Medicine, Department of Pediatrics, Primary Children's Hospital (A Hatch), Salt Lake City
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  • Author Footnotes
    1 Present/permanent addresses: University of Washington School of Medicine, Department of Pediatrics, Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA 98105.
    2 Present/permanent addresses: Brooke Army Medical Center, Uniformed Services University of the Health Sciences, 3551 Roger Brooke Dr, Fort Sam Houston, TX 78234.
Published:December 26, 2022DOI:https://doi.org/10.1016/j.acap.2022.12.009

      Abstract

      Objective

      We sought to develop and validate a list of ICD-10-CM codes identifying abusive head trauma (AHT).

      Methods

      Subjects included all children under 2 years with head trauma seen in the emergency department or admitted to one of 5 medical centers. Cases were classified as AHT, accidental head injury, or indeterminate based on chart review of the medical record. ICD-10-CM code list to identify cases of AHT was developed based on prior head injury code lists. Sensitivity and specificity of the final code list were calculated.

      Results

      There were 2883 patients in the study population of whom 524 had AHT, 2123 had accidental injury, and 236 were indeterminate cases. The final list of AHT codes had a sensitivity of 76.1% (95% CI 72.5–79.8) and a specificity of 98.5% (95% CI 98.0–99.0) when limiting analyses to the groups with identified cause of injury (accidental vs abusive). Misclassification of cases based on codes resulting in false positives and false negatives was due to coding errors.

      Conclusions

      The list of ICD-10-CM codes can be utilized to identify and track cases of AHT at a national level in large administrative datasets though likely underestimates true injury burden.

      Keywords

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