title: Assessing the accuracy of the International Classification of Diseases codes to identify abusive head trauma: a feasibility study.
abstract: 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.
authors.affiliation: Department of Pediatrics, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania, USA.
authors.forename: Rachel P
authors.initials: RP
authors.lastname: Berger
authors.affiliation: National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
authors.forename: Sharyn
authors.initials: S
authors.lastname: Parks
authors.affiliation: Department of Pediatrics, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania, USA.
authors.forename: Janet
authors.initials: J
authors.lastname: Fromkin
authors.affiliation: Department of Pediatrics, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania, USA.
authors.forename: Pamela
authors.initials: P
authors.lastname: Rubin
authors.affiliation: Casey Family Programs, School of Social Work, University of Washington, Seattle, Washington, USA.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Pecora
mesh_terms: D001930:Brain Injuries / Q000175:diagnosis; D002649:Child Abuse / Q000175:diagnosis*; D002675:Child, Preschool; D006259:Craniocerebral Trauma / Q000175:diagnosis* / Q000209:etiology; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007223:Infant; D038801:International Classification of Diseases / Q000592:standards*; D008297:Male; D012680:Sensitivity and Specificity