背景：為了提高不同兒虐頭傷研究或監測的可比較性，美國疾病管制署於2012年集結專家訂出一套依照國際疾病分類編碼臨床修訂第九版編碼的非致命兒虐頭傷定義與依照國際疾病分類編碼第十版的致命兒虐頭傷定義。美國在2015年10月，台灣在2016年1月都改為臨床修訂第十版。可是，目前尚未有採用臨床修訂第十版非致命兒虐頭傷相關研究或監測。
目的：首先探討兒虐頭傷臨床修訂第九版編碼轉譯為臨床修訂第十版的銜接度，接著比較使用這兩版進行兒虐頭傷發生率的流行病學輪廓是否有差異。
方法：首先使用美國國立衛生統計中心公告的一般對應地圖探討美國疾管署臨床修訂第九版非致命兒虐頭傷定義改為臨床修訂第十版的對應差異。接著使用2010至2019年台灣全民健保門診與住院申報資料，依照前述定義分析出五歲以下兒虐頭傷的發生率與相關影響因素。本研究進一步使用醫令碼探討嚴重度，以及追蹤五年後神經功能預後及死亡情形。
結果：在非致命兒虐頭傷狹義定義臨床修訂第十版比致命兒虐頭傷第十版多18個相關編碼，廣義定義多了14個編碼。使用申報資料估計發生率，僅針對住院個案，狹義與義定義個案數分別為362與392，後者比前者多了8%。如果加上急診申報資料，狹義與義定義個案數分別為480與533，後者比前者多了11%。不論是狹義定義或廣義定義，整體發生率年代趨勢差不多，但在2014年至2015年間，兒虐頭傷的人數有增加的現象。在年齡層方面，台灣兒虐頭傷個案以年齡為一歲以下者占最多數，其中又有超過一半以上個案其年齡為小於六個月。在性別方面，2015年前男性發生率大於女性發生率，但在2015年後則是女性多於男性。兒虐頭傷的死亡率約為15%，年齡越高死亡風險也越高。有將近一半的兒虐頭傷個案於追蹤期間會有發展遲緩的後遺症。
結論：根據不同資料來源不同定義會估計出不同兒虐頭傷發生率，建議研究者應該都要呈現，讓相關決策者參考。建議未來還要針對上述定義與嚴重度的國際疾病編碼審定程序進行準確度研究。

Background: To improve the comparability of different studies on pediatric abusive head trauma (AHT), the Centers for Disease Control and Prevention(CDC) in the United States developed an International Classification of Diseases (ICD) coding algorithm for non-fatal AHT based on Ninth Revision Clinical Modification (ICD-9-CM) and for fatal AHT based on Tenth Revision (ICD-10) in 2012. The Tenth Revision Clinical Revision (ICD-10-CM) was introduced in October, 2015 in the United States and January, 2016 in Taiwan. However, no AHT study used ICD-10-CM definition for non-fatal AHT was performed. Objective: We sought in this study to develop an CDC ICD-10-CM version for non-fatal AHT and to delineate the epidemiological profile of HAT in Taiwan from 2010 through 2019. Methods: We firstly used general equivalence mappings developed by the US National Center for Health Statistics to determine the ICD-10-CM version of CDC non-fatal AHT definitions. We then used Taiwan National Health Insurance outpatients and inpatients claims data for years 2010 through 2019 to estimate the incidence of non-fatal AHT according to the two versions of definitions. Thirdly, we used treatment codes in claims data to proxy measure the severity of non-fatal AHT and five year logn-term neurological deficit outcomes. Results: The number of AHT based on inpatients claims data according to narrow and broad definition was 362 and 392, respectively, an 8% more cases. If we based both emergency visits and inpatients claims the number of AHT was 480 and 533, respectively, an 11% more cases. The pattern of incidence trends were similar according to two definitions; however, an increase of incidence was note during 2014-2015. More than half of the AHT cases were younger than six months. Before 2015, the incidence among boys was higher than girls; however, inversed after 2016. The estimated mortality among AHT was 15% and increased with age. More thant half of the cases had sequelae of development delay during the follow-up period. Conclusions: Incidence of AHT varied according to different definitions and based on different data sources, we suggested that researchers should reveal the whole picture for stakeholders. Further validity studies on ICD coding algorithms of different definitions and proxy measures of severity are needed.

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