Study Design and Surveillance

Adoption of ICD-10 in emergency departments has been linked to improved accuracy of clinical documentation and patient outcomes. Each affected birth was counted once for overall prevalence, even if multiple anomalies were present. Major external structural anomalies were classified using WHO, ICBDSR, and ICD-10 guidance. ICD-10 is well established in Malaysian inpatient and daycare settings but is not routinely used in emergency departments. ICD-10 code utilisation was highly skewed, with nearly three-quarters of codes used five times or fewer and over 40% used only once. Formal inter-coder reliability metrics such as Cohen's kappa were not calculated during the study, as coding verification was operational rather than research-designed. ICD-10, developed by the WHO, provides a globally standardised framework for coding and classifying diagnoses that enables consistent documentation, cross-system comparison, and epidemiological surveillance. The study was an institution-based retrospective record review covering October 2020 through December 2023. Data collection reviewed 54,626 delivery records using a structured questionnaire adapted from WHO guidance. Across 9,942 ED records, 9…