Chinese Journal of Evidence -Based Pediatric ›› 2019, Vol. 14 ›› Issue (5): 347-354.DOI: 10.3969/j.issn.1673-5501.2019.05.006

• Original Papers • Previous Articles     Next Articles

A cross-section study based on the front page of the inpatient medical records – The diagnostic spectrum and demographic characteristics of kidney disease treated in the department of pediatric nephrology of a national children’s medical center

ZHAI Yi-hui1,2, SHI Peng1, RAO Jia1,2, CHEN Jing1,2, FANG Xiao-yan1,2, MIAO Qian-fan1,2, ZHANG Zhi-qing1,2, LIU Jia-lu1,2, TANG Xiao-shan1,2, LIU Jiao-jiao1,2, CAO Qi1,2, GUO Wei1,2, YE Cheng-jie1, GE Xiao-ling1, ZHANG Xiao-bo1, SHEN Qian1,2, XU Hong1,2   

  1. 1 Children's Hospital of Fudan University;
    2 Shanghai Kidney Development & Pediatric Kidney Disease Research Center, Shanghai, 201102, China
  • Received:2019-10-18 Online:2019-10-25
  • Contact: XU Hong, E-mail:hxu@shmu.edu.cn;SHEN Qian, E-mail:shenqian@shmu.edu.cn

Abstract: Objective The front page of inpatient medical records consists of structured data domains including demography, diagnosis, procedures and hospitalization expenditure. To explore and develop an analysis method based on the medical big data of the front page of inpatient medical records and describe the brief characteristics of medical service provided by pediatric nephrology in a national children's medical center.Methods We performed a cross section study based on the data of the front page of the inpatient medical records from January 1, 2014 to December 31, 2018 derived from the pediatric nephrology department in the hospital information system (HIS). After data desensitization, the selected data elements on the structured front page were extracted, and the backup database DASF-PEKDI (a database searched by fields for pediatric kidney disease inpatients)was established. The ICD codes were mapped to a standardized version. The current addresses were simplified to provinces and cities. The repository of ICD diagnostic codes of renal (related) disease was established and classified into 14 categories: primary glomerular disease, secondary glomerular disease, genetic glomerular disease, renal tubular disease, urinary tract infection, congenital abnormality of kidney and urinary tract, urolithiasis, renal angiopathy, nocturnal enuresis, renal tumors, renal insufficiency / renal failure, renal replacement therapy, hematuria / proteinuria and others.Results In HIS of our hospital, 7,898 inpatient medical records of pediatric nephrology identified on the front page of inpatient medical records were retrieved. One thousand and ninety-one ICD-10 diagnostic codes were derived from DASF-PEKDI, among which 285 were diagnostic codes of renal (related) disease, including codes of diseases requiring differentiation with renal diseases, codes of morbidity and post-operational status. Among 285 diagnositic codes, 227 codes belonged to specific renal disease. Three codes of procedure (ICD-9-CM-3) were also included. Three thousand nine hundred and sixty three patients (7,898 cases) were discharged from department of pediatric nephrology, among which 90.1% (3,571 patients) were with renal (related) diseases, with a median age of 5.8 years (0-20 years), and 61.3% of them were male children. Among 7,898 cases, patients living outside Shanghai during the five years increased from 72.1% in 2014 to 85.7% in 2018. The average hospitalization cost was 13,716 RMB and the average hospitalization duration was 9.4 days. Primary nephrotic syndrome accounted for 78.1% of the primary glomerular disease. Henoch-Schonlein purpura nephritis and lupus nephritis accounted for 78.4% of secondary kidney disease. The proportion of CAKUT diagnosis increased from 9.3% in 2014 to 15.3% in 2018. Chronic kidney disease (stage 2-5) accounted for 90.7% of renal insufficiency / renal failure. The modality of renal replacement therapy includes peritoneal dialysis (62.2%), hemodialysis (12.6%) and kidney transplantation (25.2%).Conclusion The structured data elements on the front page of inpatient medical records provide a new tool to accelerate clinical study through data capture and analysis. The authors developed a front page based analysis method. The diagnosis spectrum of renal diseases on the front page of inpatient medical record needs to be standardized based on ICD-10 codes, and the database and classification of renal (related) diseases should be established, so as to further accurately analyze the demographic and characteristics of kidney disease of inpatients in the department of pediatric nephrology.

Key words: Diagnostic spectrum, Front page, Hospital information system, ICD-10 codes, Inpatient medical records, National children's medical center, Pediatric nephrology