Migowa Angela, Colmegna Inés, Hitchon Carol, Were Eugene, Ng'ang'a Evelyn, Ngwiri Thomas, Wachira John, Bernatsky Sasha, Scuccimarri Rosie
Division of Pediatric Rheumatology, Department of Pediatrics, McGill University Health Centre, 1001 Decarie Boulevard, Room A04.6306, Montreal, QC, Canada, H4A 3J1.
Division of Rheumatology, Department of Medicine, McGill University Health Centre, Montreal, QC, Canada.
Pediatr Rheumatol Online J. 2017 Jan 14;15(1):4. doi: 10.1186/s12969-016-0131-3.
Pediatric rheumatic diseases are chronic illnesses that can cause considerable disease burden to children and their families. There is limited epidemiologic data on these diseases in East Africa. The aim of this study was to assess the spectrum of pediatric rheumatic diagnoses in an in-patient setting and determine the accuracy of ICD-10 codes in identifying these conditions.
Medical records from Gertrude's Children's Hospital in Kenya were reviewed for patients diagnosed with "diseases of the musculoskeletal system and connective tissue" as per ICD-10 diagnostic codes assigned at discharge between January and December 2011. Cases were classified as "rheumatic" or "non-rheumatic". Accuracy of the assigned ICD-10 code was ascertained. Death records were reviewed. Longitudinal follow-up of "rheumatic" cases was done by chart review up to March 2014.
Twenty six patients were classified as having a "rheumatic" condition accounting for 0.32% of patients admitted. Of these, 11 (42.3%) had an acute inflammatory arthropathy, 6 (23.1%) had septic arthritis, 4 (15.4%) had Kawasaki disease, 2 (7.7%) had pyomyositis, and there was one case each of septic bursitis, rheumatic fever, and a non-specific soft tissue disorder. No cases of juvenile idiopathic arthritis (JIA) were identified. One case of systemic lupus erythematosus was documented by death records. The agreement between the treating physician's discharge diagnosis and medical records ICD-10 code assignment was good (Kappa: 0.769). On follow-up, one child had recurrent knee swelling that was suspicious for JIA.
Pediatric rheumatic conditions represented 0.32% of admissions at a pediatric hospital in Kenya. Acute inflammatory arthropathies, septic arthritis and Kawasaki disease were the most frequent in-patient rheumatic diagnoses. Chronic pediatric rheumatic diseases were rare amongst this in-patient population. Despite limitations associated with the use of administrative diagnostic codes, they can be a first step in evaluating the spectrum of pediatric rheumatic conditions in Kenya and other countries in East Africa.
儿童风湿性疾病是慢性疾病，会给儿童及其家庭带来相当大的疾病负担。东非关于这些疾病的流行病学数据有限。本研究的目的是评估住院环境中儿童风湿性疾病的诊断范围，并确定国际疾病分类第十版（ICD - 10）编码在识别这些病症方面的准确性。
回顾了肯尼亚格特鲁德儿童医院2011年1月至12月出院时根据ICD - 10诊断编码诊断为“肌肉骨骼系统和结缔组织疾病”的患者的病历。病例分为“风湿性”或“非风湿性”。确定所分配的ICD - 10编码的准确性。审查了死亡记录。通过病历审查对“风湿性”病例进行了长达2014年3月的纵向随访。
26名患者被归类为患有“风湿性”疾病，占住院患者的0.32%。其中，11例（42.3%）患有急性炎症性关节炎，6例（23.1%）患有化脓性关节炎，4例（15.4%）患有川崎病，2例（7.7%）患有脓性肌炎，还有1例化脓性滑囊炎、1例风湿热和1例非特异性软组织疾病。未发现幼年特发性关节炎（JIA）病例。死亡记录中有1例系统性红斑狼疮病例。主治医生的出院诊断与病历ICD - 10编码分配之间的一致性良好（kappa值：0.769）。随访中，1名儿童膝关节反复肿胀，怀疑患有JIA。
儿童风湿性疾病占肯尼亚一家儿童医院住院患者的0.32%。急性炎症性关节炎、化脓性关节炎和川崎病是最常见的住院风湿性诊断疾病。慢性儿童风湿性疾病在该住院人群中很少见。尽管使用行政诊断编码存在局限性，但它们可以作为评估肯尼亚和东非其他国家儿童风湿性疾病范围的第一步。
