Chronic pain is common among children and adolescents; however, the diagnoses in the newly developed 11th revision of the International Classification of Diseases (ICD-11) chronic pain chapter are based on adult criteria, overlooking pediatric neurodevelopmental differences. The chronic pain diagnoses have demonstrated good clinical applicability in adults, but to date, no field study has examined these diagnoses to the most specific diagnostic level in a pediatric sample. The current study aimed to explore pediatric representation within the ICD-11, with focus on chronic primary pain. Healthcare professionals (HCPs) at a specialized pediatric pain center documented the symptoms of and assigned both ICD-10 and ICD-11 diagnoses to N = 402 patients. Using criteria-based computer algorithms, specific ICD-11 pain diagnoses were allocated for each documented pain location, with residual diagnoses (ie, "unspecified") assigned if criteria were not (fully) met. Within the ICD-11, the algorithms assigned specific pain diagnoses to most patients (73.6%). In ICD-10, HCPs could not specify a diagnosis for 5.2% of patients; the ICD-11 algorithm allocated a residual chronic primary pain diagnosis in 51.2%. Residual categories were especially prevalent among younger children, boys, patients with headaches, and those with lower pain severity. Overall, clinical utility of the ICD-11 was high, although less effective for chronic back pain and headache diagnoses. The latter also exhibited the lowest agreement between HCPs and algorithm. The current study underscores the need for evidence-based improvements to the ICD-11 diagnostic criteria in pediatrics. Developing pediatric coding notes could improve the visibility of patients internationally and improve the likelihood of receiving reimbursement for necessary treatments through accurate coding.

中文翻译：

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国际疾病分类第 11 次修订儿童和青少年慢性原发性疼痛诊断：儿科患者在新分类系统中的代表性。


慢性疼痛在儿童和青少年中很常见;然而，新制定的国际疾病分类 （ICD-11） 慢性疼痛章节第 11 次修订版中的诊断是基于成人标准，忽略了儿科神经发育差异。慢性疼痛诊断在成人中具有良好的临床适用性，但迄今为止，还没有现场研究将这些诊断检查到儿科样本中最具体的诊断水平。目前的研究旨在探索 ICD-11 中的儿科表现，重点是慢性原发性疼痛。专业儿科疼痛中心的医疗保健专业人员 （HCP） 记录了 N = 402 名患者的症状，并将 ICD-10 和 ICD-11 诊断分配给 N = 402 名患者。使用基于标准的计算机算法，为每个记录的疼痛部位分配特定的 ICD-11 疼痛诊断，如果标准未（完全）满足，则分配残余诊断（即“未指定”）。在 ICD-11 中，算法为大多数患者分配了特定的疼痛诊断 （73.6%）。在 ICD-10 中，HCP 无法为 5.2% 的患者指定诊断;ICD-11 算法分配了 51.2% 的残余慢性原发性疼痛诊断。残余类别在年幼儿童、男孩、头痛患者和疼痛严重程度较低的患者中尤为普遍。总体而言，ICD-11 的临床效用很高，但对慢性背痛和头痛诊断的效果较差。后者也表现出 HCP 和算法之间的最低一致性。目前的研究强调了对儿科 ICD-11 诊断标准进行循证改进的必要性。 开发儿科编码记录可以提高患者的国际知名度，并通过准确的编码提高获得必要治疗报销的可能性。