The utility and challenges of using ICD codes in child maltreatment research: A review of existing literature

Child Abuse Negl. 2009 Nov;33(11):791-808. doi: 10.1016/j.chiabu.2009.08.005. Epub 2009 Oct 23.


Objective: The objectives of this article are to explore the extent to which the International Statistical Classification of Diseases and Related Health Problems (ICD) has been used in child abuse research, to describe how the ICD system has been applied, and to assess factors affecting the reliability of ICD coded data in child abuse research.

Methods: PubMed, CINAHL, PsychInfo and Google Scholar were searched for peer reviewed articles written since 1989 that used ICD as the classification system to identify cases and research child abuse using health databases. Snowballing strategies were also employed by searching the bibliographies of retrieved references to identify relevant associated articles. The papers identified through the search were independently screened by two authors for inclusion, resulting in 47 studies selected for the review. Due to heterogeneity of studies meta-analysis was not performed.

Results: This paper highlights both utility and limitations of ICD coded data. ICD codes have been widely used to conduct research into child maltreatment in health data systems. The codes appear to be used primarily to determine child maltreatment patterns within identified diagnoses or to identify child maltreatment cases for research.

Conclusions: A significant impediment to the use of ICD codes in child maltreatment research is the under ascertainment of child maltreatment by using coded data alone. This is most clearly identified and, to some degree, quantified, in research where data linkage is used.

Practice implications: The importance of improved child maltreatment identification will assist in identifying risk factors and creating programs that can prevent and treat child maltreatment and assist in meeting reporting obligations under the CRC.

Publication types

  • Review

MeSH terms

  • Adolescent
  • Child
  • Child Abuse / classification*
  • Child Abuse / diagnosis*
  • Child Abuse / prevention & control
  • Child Abuse / statistics & numerical data
  • Child Advocacy / legislation & jurisprudence
  • Child, Preschool
  • Cross-Sectional Studies
  • Health Care Costs / statistics & numerical data
  • Humans
  • Incidence
  • Infant
  • International Classification of Diseases*
  • Mandatory Reporting
  • Research
  • Wounds and Injuries / classification
  • Wounds and Injuries / diagnosis
  • Wounds and Injuries / economics
  • Wounds and Injuries / prevention & control