European journal of pediatrics · 2025
The use of ICD-10 coding for children hospitalized with suspected child physical abuse at a tertiary care pediatric hospital in Greece.
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Karadima Eleftheria, Panos Alexandros, Leventhal John M, Soldatou Alexandra
Аннотация
PURPOSE: Child physical abuse (CPA) is under-documented in hospital databases, posing challenges for its identification. The use of abuse-specific ICD-10 codes in identifying suspected CPA cases remains limited. This study investigated the use of ICD-10 codes to document suspected CPA cases in a pediatric hospital in Greece.
METHODS: We examined data from all hospitalized children younger than 18 years evaluated for suspected CPA by the country's first Child Safety Care Unit (CSCU) between June 2016 and September 2021. ICD-10 codes extracted from the hospital's electronic medical records (EMR) were compared with those assigned in the CSCU database by child abuse pediatricians (CAPs). CAPs also rated the likelihood of abuse for each case using the Thomas-Leventhal Scale, a 7-point clinical abuse scale.
RESULTS: Of the 119 cases evaluated, significant discrepancies were observed between the ICD-10 codes used in the EMR and those assigned by CAPs in the CSCU. In 61.3% of cases, there was no overlap in ICD-10 codes. In the EMR, there was underutilization of specific ICD-10 codes to identify cases of suspected CPA and predominant use of general, non-specific codes. Based on the Thomas-Leventhal Scale, cases assigned specific CPA codes by CAPs had a higher likelihood of abuse.
CONCLUSION: Underutilization of specific ICD-10 codes in this hospital's EMR hindered accurate CPA identification. Implementing systematic coding practices, including the integration of tools, such as the Thomas-Leventhal Scale, alongside ICD-10 coding, or allowing CAPs to code during consultations, may enhance CPA documentation and support screening and intervention strategies in pediatric hospitals.
WHAT IS KNOWN: • Child physical abuse (CPA) remains under-documented in hospital databases. • Abuse-specific ICD-10 codes are underused by physicians, resulting in low sensitivity for CPA detection.
WHAT IS NEW: • In a Greek hospital, the underutilization of specific ICD-10 codes for CPA or accidents and the predominant use of general codes hinder accurate CPA identification in the Electronic Medical Records (EMR). • The systematic use of the Thomas-Leventhal Scale and EMR coding by Child Abuse Pediatricians (CAPs) could improve CPA documentation and enhance the accuracy of abuse identification in hospital databases.
METHODS: We examined data from all hospitalized children younger than 18 years evaluated for suspected CPA by the country's first Child Safety Care Unit (CSCU) between June 2016 and September 2021. ICD-10 codes extracted from the hospital's electronic medical records (EMR) were compared with those assigned in the CSCU database by child abuse pediatricians (CAPs). CAPs also rated the likelihood of abuse for each case using the Thomas-Leventhal Scale, a 7-point clinical abuse scale.
RESULTS: Of the 119 cases evaluated, significant discrepancies were observed between the ICD-10 codes used in the EMR and those assigned by CAPs in the CSCU. In 61.3% of cases, there was no overlap in ICD-10 codes. In the EMR, there was underutilization of specific ICD-10 codes to identify cases of suspected CPA and predominant use of general, non-specific codes. Based on the Thomas-Leventhal Scale, cases assigned specific CPA codes by CAPs had a higher likelihood of abuse.
CONCLUSION: Underutilization of specific ICD-10 codes in this hospital's EMR hindered accurate CPA identification. Implementing systematic coding practices, including the integration of tools, such as the Thomas-Leventhal Scale, alongside ICD-10 coding, or allowing CAPs to code during consultations, may enhance CPA documentation and support screening and intervention strategies in pediatric hospitals.
WHAT IS KNOWN: • Child physical abuse (CPA) remains under-documented in hospital databases. • Abuse-specific ICD-10 codes are underused by physicians, resulting in low sensitivity for CPA detection.
WHAT IS NEW: • In a Greek hospital, the underutilization of specific ICD-10 codes for CPA or accidents and the predominant use of general codes hinder accurate CPA identification in the Electronic Medical Records (EMR). • The systematic use of the Thomas-Leventhal Scale and EMR coding by Child Abuse Pediatricians (CAPs) could improve CPA documentation and enhance the accuracy of abuse identification in hospital databases.