Assessing the accuracy of the International Classification of Diseases codes to identify abusive head trauma: a feasibility study

Inj Prev. 2015 Apr;21(e1):e133-7. doi: 10.1136/injuryprev-2013-040924. Epub 2013 Oct 28.


Objective: To assess the accuracy of an International Classification of Diseases (ICD) code-based operational case definition for abusive head trauma (AHT).

Methods: Subjects were children <5 years of age evaluated for AHT by a hospital-based Child Protection Team (CPT) at a tertiary care paediatric hospital with a completely electronic medical record (EMR) system. Subjects were designated as non-AHT traumatic brain injury (TBI) or AHT based on whether the CPT determined that the injuries were due to AHT. The sensitivity and specificity of the ICD-based definition were calculated.

Results: There were 223 children evaluated for AHT: 117 AHT and 106 non-AHT TBI. The sensitivity and specificity of the ICD-based operational case definition were 92% (95% CI 85.8 to 96.2) and 96% (95% CI 92.3 to 99.7), respectively. All errors in sensitivity and three of the four specificity errors were due to coder error; one specificity error was a physician error.

Conclusions: In a paediatric tertiary care hospital with an EMR system, the accuracy of an ICD-based case definition for AHT was high. Additional studies are needed to assess the accuracy of this definition in all types of hospitals in which children with AHT are cared for.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Brain Injuries / diagnosis
  • Child Abuse / diagnosis*
  • Child, Preschool
  • Craniocerebral Trauma / diagnosis*
  • Craniocerebral Trauma / etiology
  • Feasibility Studies
  • Female
  • Humans
  • Infant
  • International Classification of Diseases / standards*
  • Male
  • Sensitivity and Specificity