ICD-10-CM Codes for the Identification of Abusive Head Trauma in Administrative Datasets

Abstract

Objective: We sought to develop and validate a list of ICD-10-CM codes identifying abusive head trauma (AHT).

Methods: Subjects included all children under 2 years with head trauma seen in the emergency department or admitted to one of 5 medical centers. Cases were classified as AHT, accidental head injury, or indeterminate based on chart review of the medical record. ICD-10-CM code list to identify cases of AHT was developed based on prior head injury code lists. Sensitivity and specificity of the final code list were calculated.

Results: There were 2883 patients in the study population of whom 524 had AHT, 2123 had accidental injury, and 236 were indeterminate cases. The final list of AHT codes had a sensitivity of 76.1% (95% CI 72.5-79.8) and a specificity of 98.5% (95% CI 98.0-99.0) when limiting analyses to the groups with identified cause of injury (accidental vs abusive). Misclassification of cases based on codes resulting in false positives and false negatives was due to coding errors.

Conclusions: The list of ICD-10-CM codes can be utilized to identify and track cases of AHT at a national level in large administrative datasets though likely underestimates true injury burden.

Keywords: ICD-10-CM; abusive head trauma (AHT); validation.