Background/Purpose: Pediatric rheumatic diseases are among the most common chronic illnesses of childhood and can cause considerable disease burden and disability. The frequency and outcomes of pediatric rheumatic conditions in East Africa are unknown. Defining the spectrum of inpatient diagnoses is critical to designing a context-specific educational program targeting African pediatricians and pediatric trainees to improve diagnosis and treatment of children with these conditions.

Methods: In order to assess the spectrum of diseases seen on the inpatient service from January to December 2011 at Gertrude’s Children Hospital, the largest pediatric center in East-Africa, patients identified as having diseases of the musculoskeletal (MSK) system and connective tissues (CT) by ICD-10 diagnostic codes (‘M-codes’) at discharge were included.  After IRB approval, the admission records of these patients were reviewed locally and the de-identified information sent to the McGill investigators. Diagnoses were validated by two independent rheumatologists using information gathered from the medical records as well as laboratory and microbiology investigations. True cases were defined as those with recorded clinical evidence corresponding to the standard definition of the ‘M-code’ assigned by the local physician. Frequencies of each ‘M-code’ identified were then calculated. 

Results: The total number of admissions to Gertrude’s Hospital during 2011 was 8,011. Among those, 35 patients were  identified as having an ‘M-code’ diagnosis at discharge. When the records were reviewed, non-MSK conditions accounted for 20% (7 cases) of all ‘M-code’ admissions. Minor surgical procedures made up 14.3% (5 cases). When both of these were excluded, diseases of the MSK system and CT represented 0.28% of the total admissions in 2011. Validated diagnoses were classified as inflammatory arthropathies (39.1% or 9 cases), septic arthritis (30.4% or 7 cases); soft tissue and muscle infections (17.4% or 4 cases) and Kawasaki disease (KD) (13.1 % or 3 cases).

Conclusion: Following the exclusion of misclassified patients and the validation of true diagnoses, diseases of the MSK and CT represented 0.28% of the total admissions to the largest pediatric referral center during 2011. The spectrum of rheumatic conditions requiring admissions included inflammatory and infectious arthropathies, soft tissue and muscle infections, and KD . Surprisingly, there were no admissions for lupus and other systemic vasculitides beyond KD during the studied time interval. This may indicate under-diagnosis of these conditions, poor sensitivity of ‘M-codes’ to identify these diseases or a true  low frequency of these diagnoses. Although using ‘M-codes’ to identify rheumatic conditions may have its limitations, this study was the first step at identifying the frequency of these conditions in this inpatient population.

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