The study found that 11.5 percent of patients in this sample had emergency department (ED) ICD (International Classification of Diseases) codes that included the possibility of abuse, 22.7 percent had the possibility for abuse noted by a physician in an ED discharge diagnosis, and 35.6 percent of all admitted patients and almost 62 percent of confirmed abuse cases had abuse-related admission ICD codes in their files. The study also found that being female was associated with a greater probability of having ED ICD abuse codes. This study examined the proportion of fracture cases investigated in hospital EDs for abuse that had corresponding ICD codes documenting suspicion of abuse. Data for the study were obtained from a sample (n=216) of children under the age of 3 who presented primarily with a fracture to 2 large academic children's hospitals between 1997 and 2007. The data were analyzed to determine the proportion of cases where abuse suspicion was reflected in ED discharge ICD codes. The findings indicate that current standards for ICD coding do not properly reflect the significant number of children assessed in EDs and hospital wards for possible and confirmed fractures resulting from child physical abuse. Figure, tables, and references