Defining Sentinel Injuries of Suspected Child Abuse by Age Using International Classification of Diseases-10: A Delphi Study.

OBJECTIVE: To address child abuse effectively requires accurate assessment of the magnitude of the problem. Although it is difficult to assess the scale of child abuse cases nationwide, it can be estimated through the incidence of sentinel injuries, which are defined as minor but unusual injuries such as bruises or wounds in children of precruising age. Therefore, this study aimed to define disease codes for sentinel injuries by age as a preliminary study to elucidate the incidence of sentinel injuries among patients who visited hospitals nationwide. METHOD: This study was designed using the Delphi method with a structured questionnaire. An extensive literature review was conducted to develop the questionnaire. The 9 participants selected as experts in child abuse were all experienced pediatric emergency medicine specialists working at pediatric emergency medicine training hospitals in South Korea, and 8 participants responded to the first survey. The Delphi method comprised 3 rounds of online surveys using Google Forms and Excel sheet questionnaire via e-mail. Only questions that achieved consensus were selected and assigned a sentinel injury disease code. RESULTS: In total, 105 questions regarding the definition of sentinel injury disease codes were surveyed as to whether they should be included as sentinel injuries, categorized by type (bruises, burns, open wounds/lacerations, and others) and anatomical location. Among them, 5 (62.5%) or more participants agreed on 92 items. CONCLUSIONS: Using the Delphi method, we defined disease codes for sentinel injuries in children aged younger than 12 months, possibly enabling assessment of the incidence of child abuse based on national data. Future research is needed to validate this result and investigate the incidence of sentinel injuries using the defined disease codes and to determine their association with actual cases of child abuse.