title: The spectrum of rheumatic in-patient diagnoses at a pediatric hospital in Kenya.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Division of Pediatric Rheumatology, Department of Pediatrics, McGill University Health Centre, 1001 Decarie Boulevard, Room A04.6306, Montreal, QC, Canada, H4A 3J1.
authors.forename: Angela
authors.initials: A
authors.lastname: Migowa
authors.affiliation: Division of Rheumatology, Department of Medicine, McGill University Health Centre, Montreal, QC, Canada.
authors.forename: Inés
authors.initials: I
authors.lastname: Colmegna
authors.affiliation: Division of Rheumatology, Department of Internal Medicine, University of Manitoba, Winnipeg, MB, Canada.
authors.forename: Carol
authors.initials: C
authors.lastname: Hitchon
authors.affiliation: Department of Pediatrics, Gertrude's Children's Hospital, Nairobi, Kenya.
authors.forename: Eugene
authors.initials: E
authors.lastname: Were
authors.affiliation: Department of Pediatrics, The Nairobi Hospital, Nairobi, Kenya.
authors.forename: Evelyn
authors.initials: E
authors.lastname: Ng'ang'a
authors.affiliation: Department of Pediatrics, Gertrude's Children's Hospital, Nairobi, Kenya.
authors.forename: Thomas
authors.initials: T
authors.lastname: Ngwiri
authors.affiliation: Department of Pediatrics, Gertrude's Children's Hospital, Nairobi, Kenya.
authors.forename: John
authors.initials: J
authors.lastname: Wachira
authors.affiliation: Division of Rheumatology & Division of Clinical Epidemiology, Department of Medicine & Department of Epidemiology, Biostatistics and Occupational Health, McGill University Health Centre, McGill University, Montreal, QC, Canada.
authors.forename: Sasha
authors.initials: S
authors.lastname: Bernatsky
authors.affiliation: Division of Pediatric Rheumatology, Department of Pediatrics, McGill University Health Centre, 1001 Decarie Boulevard, Room A04.6306, Montreal, QC, Canada, H4A 3J1. rosie.scuccimarri@muhc.mcgill.ca.
authors.forename: Rosie
authors.identifier: http://orcid.org/0000-0002-7491-3318
authors.initials: R
authors.lastname: Scuccimarri
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D006760:Hospitalization; D006776:Hospitals, Pediatric / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007630:Kenya / Q000453:epidemiology; D008297:Male; D012189:Retrospective Studies; D012216:Rheumatic Diseases / Q000175:diagnosis / Q000453:epidemiology*
keywords: Diagnostic codes; Global health; ICD-10; Juvenile arthritis; Kawasaki disease; Kenya; Lupus; Pediatric rheumatology