Moving toward precision communication in pediatric oncology clinical trials: An outline of a conceptual framework to support caregiver decision-making.

Child physical abuse (CPA) is a significant public health issue with severe long-term consequences []. Effective surveillance relies on consistent case identification and reporting to inform prevention and service planning []. Hospital discharge data are widely used for surveillance of public health conditions, as they capture diagnoses and procedures at scale over time. Given the key role of healthcare professionals in recognising and documenting CPA [, ], ICD-based administrative data have become essential for national monitoring, cross-country comparisons, and policy development [–]. However, validity is often compromised by coding practices leading to systematic underreporting [, , –]. E.g., the sensitivity of ICD-10-CM for CPA codes in the United States is estimated at 55.6% []. To improve CPA identification in hospital data, many international studies have applied broader algorithmic case definitions beyond explicit CPA codes [, –]. A validated French algorithm for children aged 1 month to 5 years showed good performance (positive predictive value, PPV, 86.3%) [] and has been applied in comparative European analyses [, ]. In Germany, CPA can be documented within the G-DRG (Diagnosis Related Group) system using the ICD-10-GM code T74.1 (“physical abuse”). However, T74.1 is underused or recorded infrequently [, ]. This under-coding is attributed to various factors [], including the reliance on broader indicator diagnosis codes (e.g., Z-codes). Additionally, procedural codes like OPS 1–945.x for child protection assessments are used more frequently to document CPA concerns [, ]. Consequently, CPA may be more reliably documented through injury diagnoses as well as broader indicator and procedural codes rather than through the explicit CPA code T74.1. Predefined abuse-relevant injuries can serve as an analytical window examining documentation pathways and sources of potential under-ascertainment.