Date of Award

Spring 5-2019

Degree Name

Master of Public Health (MPH)

Advisor(s)

ADRIANA PÉREZ, MS, PHD

Second Advisor

KARLA LAWSON, MPH, PHD

Abstract

Child abuse is a substantial public health problem. Numerous studies have used hospital discharge data coded using the International Classification of Diseases, 9th and 10th Editions, Clinical Modification (ICD-9 and ICD-10) to identify cases of physical abuse seen in hospitals. Published studies on the sensitivity and specificity of ICD coding for physical child abuse are limited using ICD-9, and non-existent with ICD-10. This study examined the accuracy of ICD coding for physical child abuse, among patients less than 18 years of age, who were evaluated due to concern for physical abuse by a Multidisciplinary Child Protection Team (MCPT) during 2012-2013 (n=391, using ICD-9) and 2016-2017 (n=303, using ICD-10) in a Pediatric Level I Trauma Center in Texas. Sensitivity, specificity, and positive and negative predictive values were calculated for ICD coding using the abuse determination of the MCPT as the gold standard. In 2012-2013, sensitivity of ICD-9 coding was only 21.7% (95% CI 15.2-29.3%) and specificity was 98.4% (95% CI 95.9-99.6%). In 2016-2017, sensitivity of ICD-10 coding was 31.3% (95% CI 24.7-38.6%) and specificity was 85.1% (95% CI 77.5-90.9%). False positive ICD-10 coding primarily involved the code for suspected child physical abuse (T76.12), which had no analogue under ICD-9. Few patients who were evaluated for possible physical abuse received the expected supplementary code for examination for possible physical abuse (19% in 2012-2013 and 4% in 2016-2017). Sensitivity of ICD-coding for physical abuse was very low. Researchers should be cautious in using ICD-coded datasets alone for physical child abuse surveillance.

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