Background/Purpose: Pediatric rheumatic diseases are a major cause of morbidity, frequently leading to permanent disability, impaired functional status and quality of life, and significant direct and indirect costs to patients and society. The prevalence and burden of pediatric rheumatic diseases in Sub-Saharan Africa are largely unknown. As a first step to design and promote policies to improve rheumatic patients’ outcomes, we performed a cross-sectional study to evaluate the frequency and validity of the use of musculoskeletal ICD-10 diagnostic codes among outpatients at the largest pediatric center in East-Africa and its outreach clinics.

Methods: Using the Kranium database, the electronic medical record system containing all billing data for Gertrude’s Children’s Hospital System (GHS), we extracted all diagnoses classified under the ICD-10 codes for musculoskeletal (MSK) conditions (M00-M99) from pediatric outpatient visits recorded between January and December 2011. Frequencies were calculated for each disease category and subcategory within these ICD-10 categories. For cases coded in the category ‘arthropathies’ (M00-M25), the assigned ICD-10 diagnosis was verified against the patient’s history, physical examination and investigations by two independent rheumatologists. True cases were defined as those with recorded clinical evidence corresponding to the ICD-10 code assigned by the local physician.

Results: Out of the 22 categories of all diseases in ICD-10, MSK conditions (M00-M99) were the 11^th most commonly billed category at GHS, and more frequent than neoplasms and cardiovascular codes. The period prevalence of M-code diagnoses for outpatient consults at GH was 0.52% (1,197 total M-code consults / 232,273 total consults). The most frequent M-code categories assigned by local physicians corresponded to ‘soft tissue disorders’ (M60-M79) (57% of all M-code diagnoses) and ‘arthropathies’ (31%). Among the arthropathies an over-all diagnosis agreement of 36% was found between the M-code used and the verified clinical evidence recorded with 0% of agreement for the category of ‘arthrosis’ (M15-M19), 40% for the category of ‘inflammatory arthropathies’ (M05-M14) and 31% for ’other joint disorders’ (M20-M25). Misclassification of patients with potential inflammatory and/or infectious diagnoses occurred in 50 out of 333 visits. After re-assigning diagnoses whose initial ICD-10 M code was found to be inaccurate, the most frequent MSK conditions seen were trauma (M12.5) (29%), inflammatory arthropathies (M05-M14) (20%) and pain in joint (M25.5) (15%).

Conclusion: Musculoskeletal conditions captured by M-codes are frequent among outpatient consults at the largest pediatric center in East-Africa. Trauma, inflammatory arthropathies and arthralgias all-together accounted for two-thirds of all MSK diagnoses. The lack of representation of systemic autoimmune diseases raises concern regarding their potential under-diagnosis or misclassification. Training local clinicians to recognize potential inflammatory conditions may help to improve the outcome of pediatric rheumatic disorders in Africa.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/spectrum-of-outpatient-musculoskeletal-visits-at-the-largest-pediatric-center-in-east-africa-in-2011/