{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,14]],"date-time":"2026-01-14T13:48:08Z","timestamp":1768398488949,"version":"3.49.0"},"reference-count":13,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2013,2,21]],"date-time":"2013-02-21T00:00:00Z","timestamp":1361404800000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/www.springer.com\/tdm"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Health Serv Res"],"published-print":{"date-parts":[[2013,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n          <jats:sec>\n            <jats:title>Background<\/jats:title>\n            <jats:p>Acetaminophen overdose is a major concern among the pediatric population. Our objective was to assess the validity of International Classification of Disease (ICD-9-CM) codes for identification of pediatric emergency department (ED) visits resulting from acetaminophen exposure or overdose.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods<\/jats:title>\n            <jats:p>We conducted a retrospective medical record review of ED visits at Texas Children\u2019s Hospital in Houston, Texas, between January 1, 2005, and December 31, 2010. Visits coded with 1 or more ICD-9 codes for poisoning (965, 977, and their subcodes and supplemental E-codes E850, E858, E935, E947, and E950 and their subcodes) were identified from an administrative database, and further review of the medical records was conducted to identify true cases of acetaminophen exposure or overdose. We then examined the sensitivity, positive predictive value, and percentage of false positives identified by various codes and code combinations to establish which codes most accurately identified acetaminophen exposure or overdose.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>Of 1,215 ED visits documented with 1 or more of the selected codes, 316 (26.0%) were a result of acetaminophen exposure or overdose. Sensitivity was highest (87.0%) for the combination of codes 965.4 (poisoning by aromatic analgesics, not elsewhere classified) and E950.0 (suicide and self-inflicted poisoning by analgesics, antipyretics, and antirheumatics), with a positive predictive value of 86.2%. Code 965.4 alone yielded a sensitivity of 85.1%, with a positive predictive value of 92.8%. Code performance varied among age groups and depending on the type of exposure (intentional or unintentional).<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusion<\/jats:title>\n            <jats:p>ICD-9 codes are useful for ascertaining which ED visits are a result of acetaminophen exposure or overdose within the pediatric population. However, because ICD-9 coding differs by age group and depending on the type of exposure, hypothesis-driven strategies must be utilized for each pediatric age group to avoid misclassification.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1186\/1472-6963-13-72","type":"journal-article","created":{"date-parts":[[2013,2,21]],"date-time":"2013-02-21T19:44:16Z","timestamp":1361475856000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["Validation of ICD-9-CM codes for identification of acetaminophen-related emergency department visits in a large pediatric hospital"],"prefix":"10.1186","volume":"13","author":[{"given":"Sofia","family":"de Achaval","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chris","family":"Feudtner","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shana","family":"Palla","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maria E","family":"Suarez-Almazor","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2013,2,21]]},"reference":[{"key":"2481_CR1","volume-title":"Patterns of Medication Use in the United States: A Report from the Slone Survey","author":"AA Mitchell","year":"2006","unstructured":"Mitchell AA, Kaufman DW, Rosenberg L: Patterns of Medication Use in the United States: A Report from the Slone Survey. 2006, Boston University, http:\/\/www.bu.edu\/slone\/SloneSurvey\/AnnualRpt\/SloneSurveyWebReport2006.pdf."},{"issue":"1","key":"2481_CR2","first-page":"1","volume":"55","author":"CDC","year":"2006","unstructured":"CDC: Nonfatal, unintentional medication exposures among young children--United States, 2001\u20132003. MMWR Morb Mortal Wkly Rep. 2006, 55 (1): 1-5.","journal-title":"MMWR Morb Mortal Wkly Rep"},{"issue":"15","key":"2481_CR3","doi-asserted-by":"publisher","first-page":"1858","DOI":"10.1001\/jama.296.15.1858","volume":"296","author":"DS Budnitz","year":"2006","unstructured":"Budnitz DS, Pollock DA, Weidenbach KN, Mendelsohn AB, Schroeder TJ, Annest JL: National surveillance of emergency department visits for outpatient adverse drug events. JAMA. 2006, 296 (15): 1858-1866. 10.1001\/jama.296.15.1858.","journal-title":"JAMA"},{"issue":"3","key":"2481_CR4","doi-asserted-by":"publisher","first-page":"181","DOI":"10.1016\/j.amepre.2009.05.018","volume":"37","author":"SF Schillie","year":"2009","unstructured":"Schillie SF, Shehab N, Thomas KE, Budnitz DS: Medication overdoses leading to emergency department visits among children. Am J Prev Med. 2009, 37 (3): 181-187. 10.1016\/j.amepre.2009.05.018.","journal-title":"Am J Prev Med"},{"issue":"2","key":"2481_CR5","doi-asserted-by":"publisher","first-page":"265","DOI":"10.1016\/j.jpeds.2011.07.042","volume":"160","author":"GR Bond","year":"2012","unstructured":"Bond GR, Woodward RW, Ho M: The Growing Impact of Pediatric Pharmaceutical Poisoning. J Pediatr. 2012, 160 (2): 265-270. 10.1016\/j.jpeds.2011.07.042.","journal-title":"J Pediatr"},{"issue":"1","key":"2481_CR6","doi-asserted-by":"publisher","first-page":"64","DOI":"10.3109\/15563650903397234","volume":"48","author":"J Setlik","year":"2010","unstructured":"Setlik J, Ho M, Bond GR: Emergency department use after pediatric pharmaceutical ingestion: comparison of two national databases. Clin Toxicol (Phila). 2010, 48 (1): 64-67. 10.3109\/15563650903397234.","journal-title":"Clin Toxicol (Phila)"},{"key":"2481_CR7","volume-title":"Summary Minutes of the Joint Meeting of the Nonprescription Drugs Advisory Committee and the Pediatric Advisory Committee","author":"FDA","year":"2011","unstructured":"FDA: Summary Minutes of the Joint Meeting of the Nonprescription Drugs Advisory Committee and the Pediatric Advisory Committee. 2011, FDA, http:\/\/www.fda.gov\/downloads\/AdvisoryCommittees\/CommitteesMeetingMaterials\/drugs\/NonprescriptionDrugsAdvisoryCommittee\/ucm264147.pdf."},{"key":"2481_CR8","volume-title":"ICD-9-CM Expert for Physicians, Volumes 1 and 2","author":"CJ Buck","year":"2011","unstructured":"Buck CJ: ICD-9-CM Expert for Physicians, Volumes 1 and 2. 2011, Salt Lake City: American Academy of Professional Coders, http:\/\/www.amazon.com\/ICD-9-CM-2011-Physicians-Professional-Edition\/dp\/1437725538."},{"issue":"6","key":"2481_CR9","doi-asserted-by":"publisher","first-page":"585","DOI":"10.1016\/j.amepre.2011.02.026","volume":"40","author":"DS Budnitz","year":"2011","unstructured":"Budnitz DS, Lovegrove MC, Crosby AE: Emergency department visits for overdoses of acetaminophen-containing products. Am J Prev Med. 2011, 40 (6): 585-592. 10.1016\/j.amepre.2011.02.026.","journal-title":"Am J Prev Med"},{"issue":"6","key":"2481_CR10","doi-asserted-by":"publisher","first-page":"398","DOI":"10.1002\/pds.1191","volume":"15","author":"P Nourjah","year":"2006","unstructured":"Nourjah P, Ahmad SR, Karwoski C, Willy M: Estimates of acetaminophen (Paracetamol)-associated overdoses in the United States. 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