ArticlePediatric emergency care2026
External Validation of Diagnosis Codes to Identify Pediatric Mental Health Emergency Department Visits for Aggression.
Article in Pediatric emergency care, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectiveTo externally validate a set of 9 ICD-10-CM billing diagnosis codes to identify pediatric ED encounters with agitation and aggression by determining their sensitivity and specificity compared with electronic health record (EHR) review.
methodsWe performed a retrospective cross-sectional single-test diagnostic accuracy study of mental health encounters in the pediatric ED of an academic urban children's hospital, utilizing EHR data for mental health encounters by children 6 to 18 years old from April 12, 2023, to December 30, 2023. The index test was the presence of any of 9 aggression-related diagnosis codes as utilized by Peleggi et al The reference test consisted of a structured EHR review to confirm that agitation/aggression was a reason for the visit. Sensitivity, specificity, positive predictive value and negative predictive value were calculated with 95% CIs.
resultsWe identified 855 pediatric mental health encounters (63%, 13 to 18 y old, 59% female). The diagnosis code set identified agitation/aggression in 62 encounters (7%), compared with 118 encounters (14%) confirmed to have agitation/aggression based on clinician notes. The 9 diagnosis codes yielded a sensitivity of 40% (95% CI: 31%, 49%) and specificity of 98% (95% CI: 97%, 99%) compared with EHR review, with a positive predictive value of 76% (63%, 85%) and a negative predictive value of 91% (89%, 93%).
conclusionsUpon external validation, a set of 9 billing diagnosis codes had poor sensitivity and excellent specificity for the identification of pediatric ED visits with agitation/aggression. Novel methods such as natural language processing may be needed to accurately identify pediatric ED visits with aggression/agitation.
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