Hand Trauma Case-Identification Using Administrative Data: A Systematic Review

Abstract Standardized and validated administrative case definitions, or “algorithms,” are essential to population-based hand trauma surveillance and research. This systematic review identified studies validating administrative algorithms for hand trauma. Medline, Embase, and the Cochrane Database of Systematic Reviews were searched up to February 2025. Eligible studies were randomized controlled trials or retrospective or prospective cohort studies that validated administrative case definitions or algorithms for hand trauma using medical record review as the reference standard. A total of 15 studies met the inclusion criteria. Fourteen studies validated definitions for hand, wrist, or forearm fractures, whereas only one study addressed a nonfracture injury (mallet finger). Six of the fracture studies focused on osteoporosis. Studies were conducted in nine countries and used diverse administrative data sources, including hospital discharge abstracts, national registries, and physician billing claims. Most (n = 13) used ICD-9 or ICD-10 codes from hospital or claims data. Positive predictive value (PPV) was the most frequently reported metric, ranging from 58 to 100%. Six studies focused on osteoporotic or fragility fractures, and most achieved a PPV above 90%. Most studies focused on validating fracture definitions. Algorithm performance was consistently strong across data sources and coding systems, supporting the use of administrative data to identify hand and wrist fractures for surveillance and outcomes research. Future work should extend validation to nonfracture hand trauma conditions, including tendon, nerve, and vascular injuries, and adopt standardized approaches to algorithm development and reporting.