PDF(Pubmed)
Abstract：
To assess the validity of an International Classification of Diseases (ICD) code based definition of non-fatal head trauma caused by child abuse (abusive head trauma) for population surveillance in New Zealand.
A retrospective cohort study of hospital inpatient records.
A tertiary children\'s hospital in Auckland, New Zealand.
1731 children less than 5 years of age who were discharged after a non-fatal head trauma event over a 10-year period from 1 January 2010 to 31 December 2019.
The outcome of assessment by the hospital\'s multidisciplinary child protection team (CPT) was compared with the outcome of ICD, Tenth Revision (ICD-10) discharge coding for non-fatal abusive head trauma (AHT). The ICD-10 code definition of AHT was derived from an ICD, Ninth Revision, Clinical Modification definition developed by the Centers for Disease Control, Atlanta, Georgia, which requires both a clinical diagnosis code and a cause-of-injury code.
There were 1755 head trauma events with 117 determined as AHT by the CPT. The ICD-10 code definition had a sensitivity of 66.7% (95% CI 57.4 to 75.1) and specificity of 99.8% (95% CI 99.5 to 100). There were only three false positives but 39 false negatives, with 18 of the false negatives coded with X59 (exposure to unspecified factor).
The ICD-10 code broad definition of AHT is a reasonable epidemiological tool for passive surveillance of AHT in New Zealand but it underestimates the incidence. Its performance could be improved by clear documentation of child protection conclusions in clinical notes, clarifying coding practice and removing the exclusion criteria from the definition.
A retrospective cohort study of hospital inpatient records.
A tertiary children\'s hospital in Auckland, New Zealand.
1731 children less than 5 years of age who were discharged after a non-fatal head trauma event over a 10-year period from 1 January 2010 to 31 December 2019.
The outcome of assessment by the hospital\'s multidisciplinary child protection team (CPT) was compared with the outcome of ICD, Tenth Revision (ICD-10) discharge coding for non-fatal abusive head trauma (AHT). The ICD-10 code definition of AHT was derived from an ICD, Ninth Revision, Clinical Modification definition developed by the Centers for Disease Control, Atlanta, Georgia, which requires both a clinical diagnosis code and a cause-of-injury code.
There were 1755 head trauma events with 117 determined as AHT by the CPT. The ICD-10 code definition had a sensitivity of 66.7% (95% CI 57.4 to 75.1) and specificity of 99.8% (95% CI 99.5 to 100). There were only three false positives but 39 false negatives, with 18 of the false negatives coded with X59 (exposure to unspecified factor).
The ICD-10 code broad definition of AHT is a reasonable epidemiological tool for passive surveillance of AHT in New Zealand but it underestimates the incidence. Its performance could be improved by clear documentation of child protection conclusions in clinical notes, clarifying coding practice and removing the exclusion criteria from the definition.
摘要：
目的：评估基于国际疾病分类（ICD）代码对虐待儿童造成的非致命性头部创伤（虐待性头部创伤）的定义在新西兰人口监测中的有效性。
方法：医院住院记录的回顾性队列研究。
方法：奥克兰三级儿童医院，新西兰。
方法：在2010年1月1日至2019年12月31日的10年间，1731名5岁以下儿童在非致命性头部外伤事件后出院。
方法：将医院多学科儿童保护小组（CPT）的评估结果与ICD的结果进行比较，第十次修订（ICD-10）非致命性虐待性头部创伤（AHT）的出院编码。AHT的ICD-10代码定义源自ICD，第九次修订,疾病控制中心制定的临床修改定义，亚特兰大,格鲁吉亚,这需要临床诊断代码和损伤原因代码。
结果：有1755例头部创伤事件，其中117例被CPT确定为AHT。ICD-10代码定义的灵敏度为66.7%（95%CI57.4至75.1），特异性为99.8%（95%CI99.5至100）。只有三个假阳性，但有39个假阴性，其中18个假阴性用X59编码(暴露于未指定的因素)。
结论：ICD-10编码AHT的广义定义是新西兰AHT被动监测的合理流行病学工具，但它低估了发病率。通过在临床笔记中明确记录儿童保护结论，可以提高其性能，澄清编码实践，并从定义中删除排除标准。
方法：医院住院记录的回顾性队列研究。
方法：奥克兰三级儿童医院，新西兰。
方法：在2010年1月1日至2019年12月31日的10年间，1731名5岁以下儿童在非致命性头部外伤事件后出院。
方法：将医院多学科儿童保护小组（CPT）的评估结果与ICD的结果进行比较，第十次修订（ICD-10）非致命性虐待性头部创伤（AHT）的出院编码。AHT的ICD-10代码定义源自ICD，第九次修订,疾病控制中心制定的临床修改定义，亚特兰大,格鲁吉亚,这需要临床诊断代码和损伤原因代码。
结果：有1755例头部创伤事件，其中117例被CPT确定为AHT。ICD-10代码定义的灵敏度为66.7%（95%CI57.4至75.1），特异性为99.8%（95%CI99.5至100）。只有三个假阳性，但有39个假阴性，其中18个假阴性用X59编码(暴露于未指定的因素)。
结论：ICD-10编码AHT的广义定义是新西兰AHT被动监测的合理流行病学工具，但它低估了发病率。通过在临床笔记中明确记录儿童保护结论，可以提高其性能，澄清编码实践，并从定义中删除排除标准。
