Anneka M Hooft1, Andrea G Asnes1, Nina Livingston2, Stephanie Deutsch3, Linda Cahill3, Joanne N Wood4, John M Leventhal5. 1. Department of Pediatrics, Yale School of Medicine, New Haven, Conn. 2. Department of Pediatrics, University of Connecticut School of Medicine, Connecticut Children's Medical Center, Hartford, Conn. 3. J. E. and Z. B. Butler Child Advocacy Center, Children's Hospital at Montefiore, Bronx, NY. 4. Division of General Pediatrics and Policy Lab, Children's Hospital of Philadelphia, and Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa. 5. Department of Pediatrics, Yale School of Medicine, New Haven, Conn. Electronic address: john.leventhal@yale.edu.
Abstract
OBJECTIVE: To assess the accuracy of International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM), codes in identifying cases of child physical abuse in 4 children's hospitals. METHODS: We included all children evaluated by a child abuse pediatrician (CAP) for suspicion of abuse at 4 children's hospitals from January 1, 2007, to December 31, 2010. Subjects included both patients judged to have injuries from abuse and those judged to have injuries from accidents or to have medical problems. The ICD-9-CM codes entered in the hospital discharge database for each child were compared to the decisions made by the CAPs on the likelihood of abuse. Sensitivity and specificity were calculated. Medical records for discordant cases were abstracted and reviewed to assess factors contributing to coding discrepancies. RESULTS: Of 936 cases of suspected physical abuse, 65.8% occurred in children <1 year of age. CAPs rated 32.7% as abuse, 18.2% as unknown cause, and 49.1% as accident/medical cause. Sensitivity and specificity of ICD-9-CM codes for abuse were 73.5% (95% confidence interval 68.2, 78.4), and 92.4% (95% confidence interval 90.0, 94.0), respectively. Among hospitals, sensitivity ranged from 53.8% to 83.8% and specificity from 85.4% to 100%. Analysis of discordant cases revealed variations in coding practices and physicians' notations among hospitals that contributed to differences in sensitivity and specificity of ICD-9-CM codes in child physical abuse. CONCLUSIONS: Overall, the sensitivity and specificity of ICD-9-CM codes in identifying cases of child physical abuse were relatively low, suggesting both an under- and overcounting of abuse cases.
OBJECTIVE: To assess the accuracy of International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM), codes in identifying cases of child physical abuse in 4 children's hospitals. METHODS: We included all children evaluated by a child abuse pediatrician (CAP) for suspicion of abuse at 4 children's hospitals from January 1, 2007, to December 31, 2010. Subjects included both patients judged to have injuries from abuse and those judged to have injuries from accidents or to have medical problems. The ICD-9-CM codes entered in the hospital discharge database for each child were compared to the decisions made by the CAPs on the likelihood of abuse. Sensitivity and specificity were calculated. Medical records for discordant cases were abstracted and reviewed to assess factors contributing to coding discrepancies. RESULTS: Of 936 cases of suspected physical abuse, 65.8% occurred in children <1 year of age. CAPs rated 32.7% as abuse, 18.2% as unknown cause, and 49.1% as accident/medical cause. Sensitivity and specificity of ICD-9-CM codes for abuse were 73.5% (95% confidence interval 68.2, 78.4), and 92.4% (95% confidence interval 90.0, 94.0), respectively. Among hospitals, sensitivity ranged from 53.8% to 83.8% and specificity from 85.4% to 100%. Analysis of discordant cases revealed variations in coding practices and physicians' notations among hospitals that contributed to differences in sensitivity and specificity of ICD-9-CM codes in child physical abuse. CONCLUSIONS: Overall, the sensitivity and specificity of ICD-9-CM codes in identifying cases of child physical abuse were relatively low, suggesting both an under- and overcounting of abuse cases.
Authors: Joanne N Wood; Sheyla P Medina; Chris Feudtner; Xianqun Luan; Russell Localio; Evan S Fieldston; David M Rubin Journal: Pediatrics Date: 2012-07-16 Impact factor: 7.124
Authors: M Katherine Henry; Mark R Zonfrillo; Benjamin French; Lihai Song; Chris Feudtner; Joanne N Wood Journal: Acad Pediatr Date: 2016-02-04 Impact factor: 3.107
Authors: Joanne N Wood; M Katherine Henry; Rachel P Berger; Daniel M Lindberg; James D Anderst; Lihai Song; Russell Localio; Chris Feudtner Journal: Acad Pediatr Date: 2018-08-16 Impact factor: 3.107
Authors: Daniel M Lindberg; Joanne N Wood; Kristine A Campbell; Philip V Scribano; Antoinette Laskey; John M Leventhal; Mary Clyde Pierce; Desmond K Runyan Journal: Child Abuse Negl Date: 2017-02-03
Authors: Adam J Zolotor; Desmond K Runyan; Meghan Shanahan; Christine Piette Durrance; Maryalice Nocera; Kelly Sullivan; Joanne Klevens; Robert Murphy; Marilyn Barr; Ronald G Barr Journal: JAMA Pediatr Date: 2015-12 Impact factor: 16.193