Analysis of medical records of patients with “ other neurological diseases ” admitted to Lady Ridgeway Hospital

Objective To assess the frequency of diseases categorized under “other neurological diseases” in the Indoor Morbidity and Mortality Registry (IMMR) of the Medical Record Unit of infants and children admitted to the Lady Ridgeway Hospital for Children (LRH) and coded and indexed according to the 10 th revision of the International Classification of Diseases (ICD 10) of the World Health Organization. Design Retrospective data analysis Method Data of in-ward patients, obtained from the medical record section of LRH for a period of two years (2004 and 2005), were analysed Results Two hundred and ninety nine (0.21%) [157 (52.5%) males and 142 (47.5%) females] had been categorized under “other neurological diseases”. The four major contributors were hydrocephalus 59 (20%), polyneuropathy & disorders of peripheral nervous system 44 (15%), Guillain Barre' syndrome 39 (13%) and disorders of myoneural junction & muscle 29 (10%). A family history was present in a patient with Duchenne muscular dystrophy (DMD) and a patient with limb-girdle muscular dystrophy.


Introduction
Medical record keeping is of crucial importance in managing health care; it not only helps to improve the quality of medical care but also provides easy access to necessary information required in research and statistical surveys when planning health care ___________________________________________ 1  systems.However, no database for the prevalence and the incidence of separate diseases of the nervous and muscular system of children is available in Sri Lanka.Of 49,092 discharges due to diseases of the nervous system during the year 2003 from hospitals throughout Sri Lanka, 26% were paediatric discharges (<1 year 3%, 1-4 years 7% and 5-16 years 16%) 1 .Lady Ridgeway Hospital for Children (LRH) is a tertiary referral national paediatric hospital in Sri Lanka with an annual admission of 73,554 and 69,399 of children and infants in 2004 and 2005 respectively 2 .

Objective
The aim of this study is to assess the frequency of diseases categorized under "other neurological diseases" in the Indoor Morbidity and Mortality Registry (IMMR) of the Medical Record Unit of infants and children admitted to LRH and coded and indexed according to the 10 th revision of the International Classification of Diseases (ICD 10) of the World Health Organization (WHO) 3 ."Other neurological diseases" comprise the following: and disorders of myoneural junction & muscle 29 (10%).Whilst the majority of these patients were suffering from life threatening, life long, incurable and incapaciting diseases, hydrocephalus is a treatable condition where early diagnosis is essential for surgery to be of value 4 .

G10-G13
Of the 29 patients recorded under "diseases of myoneural junction and muscle" (G70-G73) 8 were DMD and 2 were BMD.DMD and BMD are the most common form of hereditary muscular dystrophies, with an incidence of about 1/3,300 male births 5 .
Sri Lanka is a multiethnic, mutireligious, multilinguistic country with cultural diversity comprising Sinhalese 73.9%, Sri Lankan Tamils 12.7%, Indian Tamils 5.5%, Moors 7%, Burghers 0.3%, Malays 0.3% and others 0.2% 6 .Family history was present in one (12.5%)Tamil patient with DMD and in one (50%) Moor patient with limb-girdle muscular dystrophy.A positive family history is a strong sign of a genetic disease though not all familial disorders are genetic and not all genetic disorders are familial 7 .DMD and BMD are X-linked recessive allelic disorders 8,9 .Limb-girdle muscular is usually sporadic 10 but could be inherited as an autosomal dominant or recessive trait 11 .Congenital muscular dystrophies are inherited as autosomal dominant or recessive traits 12 .
The method used for the establishment of diagnosis of these patients was based on written diagnosis of the IMMR; under presentation of data is possible as patients diagnosed as having disorders of the nervous system could be possibly categorized under the index of a different chapter in ICD 10 depending on the incidental diagnosis of the presenting complaint.Confirmation of diagnosis either by immunohistochemical methods or genetic diagnosis of these cases had not been stated in the BHTs possibly due to unavailability of such service in the State sector.Establishing a genetic diagnosis confirms the inheritance pattern of the disorder and allows the risk of other family members to be determined 13 .
Maintaining medical records adequately and accurately and establishing confirmation of diagnosis by immunohistochemical methods and genetic diagnosis by the state sector for patients with "other neurological diseases" will be an important step toward effective prevention: by detection of carriers, genetic counselling and antenatal diagnosis of affected fetuses.

Table 2 Detailed report of neurological disorders at LRH in years 2004 & 2005 ICD 10 Classification
4%) in the 5-15 year age groups.Demographic characteristics of these patients are shown in Table 1.A detailed report of neurological disorders at LRH in 2004 & 2005 are shown in table 2.