Background/Purpose:  The spectrum and frequency of pediatric rheumatic conditions in East Africa are unknown. Administrative data that is systematically collected using International Classification of Disease (ICD) codes can provide insight into this issue. The aim of this study was to assess the accuracy of using ICD-10 diagnostic codes in identifying either inflammatory or infectious musculoskeletal conditions requiring hospitalization at the largest pediatric center in East-Africa.

Methods: We reviewed the hospital records of all patients identified as having diseases of the musculoskeletal (MSK) system and connective tissues (CT) by ICD-10 diagnostic codes (M-codes) at discharge from Gertrude’s Children’s Hospital in Kenya, during a one year period from January to December 2011.  ICD coding at this center is performed by medical records personnel based on the diagnosis provided by the treating physician. We evaluated the concordance rate between the physician’s diagnosis at discharge and the ICD-10 code assigned.

Results:  The total number of admissions during 2011 was 8,011. Among these, 42 patients had an “M-code” diagnosis at discharge (0.5%) and 39 of these had charts available for review. Among those with M-code diagnoses, concordance rates between the ICD-10 code assigned by an administrator and the treating physician’s discharge diagnosis was 66.7% (26/39). Specifically, when only the infectious and inflammatory categories of M-codes were included (26 cases), concordance improved to 76.9% (20/26). The specific diagnosis in those with musculoskeletal infections (n=10) included septic arthritis (7/10), pyomyositis (2/10) and infective bursitis (1/10). Seven of these cases were coded correctly (70%). The diagnoses for those with inflammatory conditions (n=16) included 4 with Kawasaki disease; 2 with inflammatory arthropathies; and 10 with non-specific inflammatory M-codes such as unspecified arthritis, arthralgia or joint effusion. The concordance among the inflammatory M-codes was 81.3% (13/16 were coded correctly including all KD cases).

Conclusion: Overall, the concordance of ICD-10 codes assigned in comparison to the physician’s discharge diagnosis for categories of inflammatory and infectious musculoskeletal conditions is acceptable. Inflammatory conditions are coded less specifically due to the physicians’ use of descriptive terms instead of definitive diagnoses at discharge. Therefore, administrative diagnostic codes could be used to estimate overall frequencies of rheumatic diseases in in-patients in East Africa however, their utility in estimating the frequency of specific inflammatory conditions is limited.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/accuracy-of-the-use-of-administrative-diagnostic-codes-to-identify-pediatric-in-patient-musculoskeletal-conditions-in-an-african-tertiary-hospital/