{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,26]],"date-time":"2026-05-26T08:05:20Z","timestamp":1779782720656,"version":"3.53.1"},"reference-count":33,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2026,5,26]],"date-time":"2026-05-26T00:00:00Z","timestamp":1779753600000},"content-version":"vor","delay-in-days":145,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatrics International"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Many countries lack comprehensive systems or standardized use of diagnostic codes to track child abuse. This study evaluated the validity of the International Classification of Diseases, 10th Revision (ICD\u201010) diagnostic codes and developed algorithms to identify physical abuse using administrative data.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We analyzed children under 10\u2009years hospitalized for injuries between April 2013 and March 2023 at a children's hospital in Japan. Child protection team records notifying local services were used as the reference standard. We assessed diagnostic, procedure, and medication codes using machine learning.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 1375 injury cases, 53 involved physical abuse, but only one used an abuse\u2010specific ICD\u201010 code, indicating limited reliability. Combining X\u2010ray and fundus examinations achieved 73.6% sensitivity (95% CI, 59.7\u201384.7) and 85.7% specificity (95% CI, 83.7\u201387.5) among children aged &lt;\u200910\u2009years and 80.9% sensitivity (95% CI, 66.7\u201390.9) and 79.1% specificity (95% CI, 76.2\u201381.7) among children aged &lt;\u20096\u2009years. Several machine learning approaches, including Lasso regression, random forest, and bootstrap classification\u2010and\u2010regression\u2010tree models, yielded broadly consistent findings.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>\n                      <jats:styled-content style=\"fixed-case\">ICD<\/jats:styled-content>\n                      \u201010 codes alone are insufficient for identifying physical abuse combining specific procedures may improve case identification for future epidemiological surveillance.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/ped.70430","type":"journal-article","created":{"date-parts":[[2026,5,26]],"date-time":"2026-05-26T07:39:59Z","timestamp":1779781199000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Validity of Diagnostic and Procedure Codes in Administrative Data to Identify Pediatric Physical Abuse"],"prefix":"10.1111","volume":"68","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8251-8094","authenticated-orcid":false,"given":"Erika","family":"Obikane","sequence":"first","affiliation":[{"name":"Department of Social Medicine National Center for Child Health and Development  Setagaya Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tomoko","family":"Nishino","sequence":"additional","affiliation":[{"name":"Department of Social Medicine National Center for Child Health and Development  Setagaya Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Harumi","family":"Sonehara","sequence":"additional","affiliation":[{"name":"Department of Psychosocial Medicine National Center for Child Health and Development  Setagaya Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9383-093X","authenticated-orcid":false,"given":"Satoko","family":"Uematsu","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine and Transport Service National Center for Child Health and Development  Setagaya Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hayato","family":"Yamana","sequence":"additional","affiliation":[{"name":"Data Science Center Jichi Medical University  Shimotsuke Tochigi Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3707-4260","authenticated-orcid":false,"given":"Aya","family":"Isumi","sequence":"additional","affiliation":[{"name":"Department of Global Health Promotion Institute of Science  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4682-4262","authenticated-orcid":false,"given":"Yui","family":"Yamaoka","sequence":"additional","affiliation":[{"name":"Department of Global Health Promotion Institute of Science  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1074-3954","authenticated-orcid":false,"given":"Takeo","family":"Fujiwara","sequence":"additional","affiliation":[{"name":"Department of Global Health Promotion Institute of Science  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1169-2893","authenticated-orcid":false,"given":"Yusuke","family":"Okubo","sequence":"additional","affiliation":[{"name":"Department of Social Medicine National Center for Child Health and Development  Setagaya Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,5,26]]},"reference":[{"key":"e_1_2_10_2_1","unstructured":"\u201cChild Maltreatment 2021 U.S. Department of Health & Human Services Administration for Children and Families Administration on Children Youth and Families Children's Bureau \u201d2023."},{"issue":"3","key":"e_1_2_10_3_1","doi-asserted-by":"crossref","first-page":"394","DOI":"10.1176\/appi.ajp.159.3.394","article-title":"Childhood Adversities Associated With Risk for Eating Disorders or Weight Problems During Adolescence or Early Adulthood","volume":"159","author":"Johnson J. G.","year":"2002","journal-title":"American Journal of Psychiatry"},{"issue":"5","key":"e_1_2_10_4_1","doi-asserted-by":"crossref","first-page":"e1240","DOI":"10.1542\/peds.2007-2403","article-title":"Obesity and Type 2 Diabetes Risk in Midadult Life: The Role of Childhood Adversity","volume":"121","author":"Thomas C.","year":"2008","journal-title":"Pediatrics"},{"issue":"2","key":"e_1_2_10_5_1","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1176\/appi.ajp.20220174","article-title":"Childhood Maltreatment and Mental Health Problems: A Systematic Review and Meta\u2010Analysis of Quasi\u2010Experimental Studies","volume":"180","author":"Baldwin J. R.","year":"2023","journal-title":"American Journal of Psychiatry"},{"issue":"6","key":"e_1_2_10_6_1","doi-asserted-by":"crossref","first-page":"607","DOI":"10.1016\/j.chiabu.2006.12.018","article-title":"Exposure to Childhood Sexual and Physical Abuse and Adjustment in Early Adulthood","volume":"32","author":"Fergusson D. M.","year":"2008","journal-title":"Child Abuse & Neglect"},{"issue":"8","key":"e_1_2_10_7_1","doi-asserted-by":"crossref","first-page":"824","DOI":"10.1001\/archpedi.156.8.824","article-title":"A 12\u2010Year Prospective Study of the Long\u2010Term Effects of Early Child Physical Maltreatment on Psychological, Behavioral, and Academic Problems in Adolescence","volume":"156","author":"Lansford J. E.","year":"2002","journal-title":"Archives of Pediatrics & Adolescent Medicine"},{"key":"e_1_2_10_8_1","doi-asserted-by":"crossref","first-page":"224","DOI":"10.1016\/j.jad.2018.02.034","article-title":"Impact of Childhood Abuse on Suicide\u2010Related Behavior: Analysis Using Marginal Structural Models","volume":"234","author":"Obikane E.","year":"2018","journal-title":"Journal of Affective Disorders"},{"issue":"4","key":"e_1_2_10_9_1","first-page":"444.e1","article-title":"Adverse Childhood Experiences and the Association With Ever Using Alcohol and Initiating Alcohol Use During Adolescence","volume":"38","author":"Dube S. R.","year":"2006","journal-title":"Journal of Adolescent Health"},{"key":"e_1_2_10_10_1","unstructured":"\u201cICD\u201010\u2010CM Official Guidelines for Coding and Reporting FY 2019 The Centers for Medicare and Medicaid Services (CMS) and The National Center for Health Statistics (NCHS) \u201d2019."},{"key":"e_1_2_10_11_1","doi-asserted-by":"crossref","unstructured":"S. E.Parks J. L.Annest H. A.Hill andD. L.Karch \u201cPediatric Abusive Head Trauma: Recommended Definitions for Public Health Surveillance and Research \u201d2012.","DOI":"10.1037\/e585042012-001"},{"key":"e_1_2_10_12_1","doi-asserted-by":"crossref","DOI":"10.1016\/j.chiabu.2022.105619","article-title":"Child Maltreatment\u2010Related Children's Emergency Department Visits Before and During the COVID\u201019 Pandemic in Connecticut","volume":"128","author":"Amick M.","year":"2022","journal-title":"Child Abuse & Neglect"},{"issue":"4","key":"e_1_2_10_13_1","doi-asserted-by":"crossref","first-page":"112","DOI":"10.1177\/003693309804300407","article-title":"A Retrospective Epidemiological Analysis of Non\u2010Accidental Head Injury in Children in Scotland Over a 15 Year Period","volume":"43","author":"Barlow K. M.","year":"1998","journal-title":"Scottish Medical Journal"},{"issue":"4","key":"e_1_2_10_14_1","doi-asserted-by":"crossref","first-page":"S157","DOI":"10.1016\/j.amepre.2007.12.021","article-title":"Using Hospital Discharge Data to Track Inflicted Traumatic Brain Injury","volume":"34","author":"Ellingson K. D.","year":"2008","journal-title":"American Journal of Preventive Medicine"},{"issue":"4","key":"e_1_2_10_15_1","doi-asserted-by":"crossref","DOI":"10.1542\/peds.2020-038489","article-title":"Emergency Visits and Hospitalizations for Child Abuse During the COVID\u201019 Pandemic","volume":"147","author":"Kaiser S. V.","year":"2021","journal-title":"Pediatrics"},{"issue":"3","key":"e_1_2_10_16_1","doi-asserted-by":"crossref","first-page":"599","DOI":"10.1542\/peds.2007-1959","article-title":"Incidence of Fractures Attributable to Abuse in Young Hospitalized Children: Results From Analysis of a United States Database","volume":"122","author":"Leventhal J. M.","year":"2008","journal-title":"Pediatrics"},{"issue":"2","key":"e_1_2_10_17_1","doi-asserted-by":"crossref","first-page":"296","DOI":"10.2105\/AJPH.2006.087783","article-title":"Public Health Surveillance of Fatal Child Maltreatment: Analysis of 3 State Programs","volume":"98","author":"Schnitzer P. G.","year":"2008","journal-title":"American Journal of Public Health"},{"issue":"7","key":"e_1_2_10_18_1","doi-asserted-by":"crossref","first-page":"665","DOI":"10.1001\/archpedi.159.7.665","article-title":"Prehospital and In\u2010Hospital Mortality: A Comparison of Intentional and Unintentional Traumatic Brain Injuries in Colorado Children","volume":"159","author":"Sills M. R.","year":"2005","journal-title":"Archives of Pediatrics & Adolescent Medicine"},{"issue":"49","key":"e_1_2_10_19_1","doi-asserted-by":"crossref","first-page":"1841","DOI":"10.15585\/mmwr.mm6949a1","article-title":"Trends in U.S. Emergency Department Visits Related to Suspected or Confirmed Child Abuse and Neglect Among Children and Adolescents Aged <18\u2009Years Before and During the COVID\u201019 Pandemic\u2014United States, January 2019\u2010September 2020","volume":"69","author":"Swedo E.","year":"2020","journal-title":"MMWR. Morbidity and Mortality Weekly Report"},{"issue":"1","key":"e_1_2_10_20_1","doi-asserted-by":"crossref","first-page":"267","DOI":"10.1111\/j.2517-6161.1996.tb02080.x","article-title":"Regression Shrinkage and Selection via the Lasso","volume":"58","author":"Tibshirani R.","year":"2018","journal-title":"Journal of the Royal Statistical Society. Series B, Methodological"},{"issue":"2","key":"e_1_2_10_21_1","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1023\/A:1018054314350","article-title":"Bagging Predictors","volume":"24","author":"Breiman L.","year":"1996","journal-title":"Machine Learning"},{"issue":"1","key":"e_1_2_10_22_1","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1023\/A:1010933404324","article-title":"Random Forests","volume":"45","author":"Breiman L.","year":"2001","journal-title":"Machine Learning"},{"issue":"2","key":"e_1_2_10_23_1","doi-asserted-by":"crossref","first-page":"410","DOI":"10.1016\/j.acap.2022.12.009","article-title":"ICD\u201010\u2010CM Codes for the Identification of Abusive Head Trauma in Administrative Datasets","volume":"23","author":"Brown E. C. B.","year":"2023","journal-title":"Academic Pediatrics"},{"issue":"1","key":"e_1_2_10_24_1","doi-asserted-by":"crossref","first-page":"80","DOI":"10.1016\/j.jpeds.2012.06.037","article-title":"Identification of Physical Abuse Cases in Hospitalized Children: Accuracy of International Classification of Diseases Codes","volume":"162","author":"Hooft A.","year":"2013","journal-title":"Journal of Pediatrics"},{"issue":"4","key":"e_1_2_10_25_1","doi-asserted-by":"crossref","first-page":"444","DOI":"10.1016\/j.acap.2015.01.008","article-title":"The Accuracy of ICD Codes: Identifying Physical Abuse in 4 Children's Hospitals","volume":"15","author":"Hooft A. M.","year":"2015","journal-title":"Academic Pediatrics"},{"issue":"1","key":"e_1_2_10_26_1","doi-asserted-by":"crossref","first-page":"i71","DOI":"10.1136\/injuryprev-2019-043513","article-title":"Accuracy of ICD\u201010\u2010CM Coding for Physical Child Abuse in a Paediatric Level I Trauma Centre","volume":"27","author":"Hughes Garza H.","year":"2021","journal-title":"Injury Prevention"},{"key":"e_1_2_10_27_1","doi-asserted-by":"crossref","DOI":"10.1186\/1471-2458-11-8","article-title":"Reliability of Routinely Collected Hospital Data for Child Maltreatment Surveillance","volume":"11","author":"McKenzie K.","year":"2011","journal-title":"BMC Public Health"},{"issue":"2","key":"e_1_2_10_28_1","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0298411","article-title":"Validity and Reliability International Classification of Diseases\u201010 Codes for All Forms of Injury: A Systematic Review","volume":"19","author":"Paleczny S.","year":"2024","journal-title":"PLoS One"},{"issue":"2","key":"e_1_2_10_29_1","doi-asserted-by":"crossref","first-page":"396","DOI":"10.1016\/j.acap.2022.06.011","article-title":"Validating Use of ICD\u201010 Diagnosis Codes in Identifying Physical Abuse Among Young Children","volume":"23","author":"Rasooly I. R.","year":"2023","journal-title":"Academic Pediatrics"},{"issue":"1","key":"e_1_2_10_30_1","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1016\/j.chiabu.2010.06.008","article-title":"Identification of ICD Codes Suggestive of Child Maltreatment","volume":"35","author":"Schnitzer P. G.","year":"2011","journal-title":"Child Abuse & Neglect"},{"issue":"1","key":"e_1_2_10_31_1","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1177\/183335830803700103","article-title":"Organisational Factors Affecting the Quality of Hospital Clinical Coding","volume":"37","author":"Santos S.","year":"2008","journal-title":"Health Information Management"},{"issue":"2","key":"e_1_2_10_32_1","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1016\/j.cjtee.2021.08.005","article-title":"Reliability of Trauma Coding With ICD\u201010","volume":"25","author":"Asadi F.","year":"2022","journal-title":"Chinese Journal of Traumatology"},{"issue":"6","key":"e_1_2_10_33_1","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2022-069199","article-title":"ICD\u201010 Codes for Surveillance of Non\u2010Fatal Abusive Head Trauma in Aotearoa New Zealand: A Retrospective Cohort Study","volume":"13","author":"Knappstein J.","year":"2023","journal-title":"BMJ Open"},{"key":"e_1_2_10_34_1","doi-asserted-by":"crossref","DOI":"10.1016\/j.chiabu.2024.106681","article-title":"Pilot Study Using Machine Learning to Improve Estimation of Physical Abuse Prevalence","volume":"149","author":"Brink F. W.","year":"2024","journal-title":"Child Abuse & Neglect"}],"container-title":["Pediatrics International"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/ped.70430","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/ped.70430","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/ped.70430","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,26]],"date-time":"2026-05-26T07:40:07Z","timestamp":1779781207000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/ped.70430"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1]]},"references-count":33,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2026,1]]}},"alternative-id":["10.1111\/ped.70430"],"URL":"https:\/\/doi.org\/10.1111\/ped.70430","archive":["Portico"],"relation":{},"ISSN":["1328-8067","1442-200X"],"issn-type":[{"value":"1328-8067","type":"print"},{"value":"1442-200X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1]]},"assertion":[{"value":"2025-07-26","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-04-15","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-05-26","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70430"}}