Validity of first-time diagnoses of congenital epidermolysis bullosa in the Danish National Patient Registry and the Danish Pathology Registry

Increased healthcare burden and comorbidity risks of pediatric patients with dystrophic epidermolysis bullosa: Analysis of Nationwide Emergency Department Sample 2015-2019

BACKGROUND

Dystrophic epidermolysis bullosa (DEB) describes a rare genetic blistering disorder characterized by fragile skin. This study aimed to classify the frequency, demographics, cost, and comorbidities associated with emergency department (ED) visits due to DEB.

METHODS

The Nationwide Emergency Department Sample (NEDS) was analyzed for pediatric (age <18) ED visits from 2015 to 2019. DEB was identified with ICD-10-CM code Q81.2. Weighted frequency, prevalence, and 95% confidence intervals (CIs) of comorbidities were determined among ED visits with and without a DEB diagnosis.

RESULTS

From 2015 to 2019, 53 (weighted 242) cases of DEB among 27,223,220 pediatric ED visits were captured. Patients with DEB were more likely to visit the ED in summer compared with those without a diagnosis of DEB (35.7% vs. 21.4%, P < .05). More than half of patients with DEB were admitted to the hospital (56.2%, 95% CI: 39.3-72.5, P < .001) versus only 3.4% (95% CI: 3.1-3.7) of other patients. For ED visits with a secondary DEB diagnosis, the top three primary diagnoses were fever, constipation, and bone marrow transplant aftercare. Patients with DEB had higher rates of hypertension, cellulitis, sepsis, acute and chronic kidney injury, esophageal obstruction, gastroesophageal reflux disease, cardiomyopathy, and anxiety, compared to patients without DEB (all P < .001).

CONCLUSIONS

DEB is a complex blistering disorder with multisystemic manifestations. Patients with DEB have significantly higher admission rates and commonly present with infectious or gastrointestinal complications. Understanding the features of ED visits due to DEB can better prepare healthcare teams and improve patient outcomes.

Increased cancer incidence among patients with hidradenitis suppurativa - a Danish nationwide register study 1977-2017

BACKGROUND

The chronic, inflammatory skin disease hidradenitis suppurativa (HS) (prevalence: 0.5%-1%, diagnostic delay: 7-10 years) primarily arises in younger adults and frequently coincides with autoimmune comorbidities and unhealthy life-styles (smoking and obesity). These factors are known to increase cancer risk, but despite this, information on cancer occurrence among HS patients is scarce.

MATERIALS AND METHODS

A nationwide retrospective register-based study assessing relative risk of cancer - overall and by anatomical site - following HS diagnosis expressed as standardized incidence ratios (SIRs), which is ratios between observed cases among all Danes diagnosed with HS since 1977 and expected cases based on cancer incidence rates of the entire Danish population during the same period.

RESULTS

Participants consisted of a cohort of 13,919 Danes with HS, who during an average of 14.2 years of follow-up developed a total of 1,193 incident cancers, corresponding to a 40% increased risk (SIR = 1.4, 95% CI: 1.3 to 1.4, p < 0.001). Increased risks were observed for cancers of the respiratory system, oral cavity and pharynx, digestive organs and peritoneum, urinary tract, and the lymphatic tissues.

INTERPRETATION

These findings underline an unmet need for health monitoring, lifestyle interventions and cancer screening if and when relevant.

Clinical Characteristics and Outcomes of Patients Hospitalized with Epidermolysis Bullosa: A Retrospective Population-Based Observational Study in Spain (2016-2021)

(1) Background: Epidermolysis bullosa (EB) comprises a group of rare skin diseases. We assessed diagnostic procedures, comorbidity profiles, length of hospital stay (LOHS), costs, and in-hospital mortality (IHM) associated with EB. (2) Methods: A retrospective, population-based observational study was performed using the Spanish National Hospital Discharge Database. Hospitalized patients with EB in Spain were identified for the period 2016 to 2021. (3) Results: A total of 677 hospitalizations were identified among 342 patients with a diagnosis of EB. Fifty percent of patients had at least one readmission during the 6-year follow-up. Notably, rehospitalizations were more common among patients aged 2-17 years. The most prevalent comorbidity was digestive disorders, which were associated with the frequency of esophageal dilatation procedures and percutaneous endoscopic gastrostomy. The longest LOHS was recorded for the 0- to 1-year age group. IHM increased with age, and the difference was statistically significant. The prevalence of malignant neoplasm was 36.88%, with cutaneous squamous cell carcinoma being the most frequent. The overall cost per hospitalized patient was estimated to be EUR 10,895.22 (SD EUR 13,394.81), with significant variations between age groups. (4) Conclusions: Readmissions are very frequent among people with EB. We observed a higher LOHS in the 0- to 1-year age group, while the highest rates of IHM were observed in patients older than 50 years. There was a substantial prevalence of comorbidities, namely, digestive disorders, infectious diseases, and especially cancer.

Incidence and Prevalence of 73 Different Genodermatoses: A Nationwide Study in Sweden

This retrospective registry-based cohort study aimed to estimate the incidence and prevalence of genodermatoses in the Swedish population and to analyse associated healthcare usage. Patients diagnosed with genodermatoses were identified from the patient registry of Sahlgrenska University Hospital (Gothenburg, Sweden) between 2016 and 2020. Clinical data from medical records were used to verify diagnoses recorded in the National Patient Registry (NPR). The NPR was then searched for International Classification of Diseases, Tenth Revision (ICD-10) codes Q80-82 and Q84 from 2001 to 2020. The local cohort included 298 patients with 36 unique genodermatosis diagnoses. Verification of these diagnoses in the NPR showed positive predictive values of over 90%. The NPR search yielded 13,318 patients with 73 unique diagnoses, including ichthyoses (n = 3,341; 25%), porokeratosis (n = 2,277; 17%), palmoplantar keratodermas (n = 1,754; 13%), the epidermolysis bullosa group (n = 1011; 7%); Darier disease (n = 770; 6%), Hailey-Hailey disease (n = 477; 4%) and Gorlin syndrome (n = 402; 3%). The incidence and prevalence of each diagnosis were calculated based on the nationwide cohort and are reported. A total of 149,538 outpatient visits were registered, a mean of 4.6 visits per patient. This study provides a valuable resource for the epidemiology of genodermatoses by reporting on the incidence and prevalence of 73 different genodermatoses.

Epidemiology of inherited epidermolysis bullosa in Germany

BACKGROUND

Epidermolysis bullosa (EB) is a rare genetic disorder manifesting with skin and mucosal membrane blistering in different degrees of severity.

OBJECTIVE

Epidemiological data from different countries have been published, but none are available from Germany.

METHODS

In this population-based cross-sectional study, people living with EB in Germany were identified using the following sources: academic hospitals, diagnostic laboratories and patient organization.

RESULTS

Our study indicates an overall EB incidence of 45 per million live births in Germany. With 14.23 per million live births for junctional EB, the incidence is higher than in other countries, possibly reflecting the availability of early molecular genetic diagnostics in severely affected neonates. Dystrophic EB was assessed at 15.58 cases per million live births. The relatively low incidence found for EB simplex, 14.93 per million live births, could be explained by late or missed diagnosis, but also by 33% of cases remaining not otherwise specified. Using log-linear models, we estimated a prevalence of 54 per million for all EB types, 2.44 for junctional EB, 12.16 for dystrophic EB and 28.44 per million for EB simplex. These figures are comparable to previously reported data from other countries.

CONCLUSIONS

Altogether, there are at least 2000 patients with EB in the German population. These results should support national policies and pharmaceutical companies in decision-making, allow more precise planning of drug development and clinical trials, and aid patient advocacy groups in their effort to improve quality of life of people with this orphan disease.

Validity of First-Time Diagnoses of Darier's Disease in the Danish National Patient Registry

Purpose

Darier's disease (DD) is a rare genetic skin disease, characterized by yellow-brown, scaly, crusted papules in seborrheic areas and specific nail changes. This study aimed to validate all first-time diagnoses of DD in Danish National Patient Registry (DNPR). The intent of the study is validation of DNPR for epidemiological and clinical studies on DD.

Patients and Methods

We identified all patients in DNPR who received their first-time diagnosis of DD between January 1, 1977 and December 31, 2018 (International Classification of Diseases [ICD]-8 code 75721 until the end of 1993: ICD-10 code Q828F thereafter). We restricted to diagnoses from departments of dermatology, where these patients are managed. We validated diagnoses against information from medical records, using predefined data extraction sheets and validation criteria. We classified diagnoses as probable when characteristic clinical features were present; confirmed when there was also genetic confirmation, histopathological confirmation and/or positive family history, or rejected (remaining patients). We estimated positive predictive values (PPVs) with 95% confidence intervals (CIs) for diagnoses overall and stratified by ICD classification, sex, age at diagnosis, year of diagnosis, type of diagnosis, and type of contact.

Results

We identified 277 first-time diagnoses of DD, of which 229 (82.7%) stemmed from departments of dermatology. Medical records were available for 196 (85.6%) of these. The overall PPVs for probable and confirmed DD were 89.3% (95% CI: 84.2–92.9) and 81.1% (95% CI: 75.1–86.0), respectively. The PPV for probable ICD-8 diagnosis (95.8% (95% CI: 82.1–99.5)) was slightly higher than that of probable ICD-10 diagnosis (88.4% (95% CI: 82.7–92.3)).

Conclusion

The validity of first-time diagnoses of DD recorded by departments of dermatology in the DNPR is relatively high, making DNPR suitable for epidemiological studies on DD in Denmark, as well as a useful source for recruitment to clinical studies on DD.

Epidermolysis Bullosa Registry Data in Iran

BACKGROUND

In many countries, there is no registry system to record data for Epidermolysis Bullosa patients. However, the first steps for establishing a registry system have been taken in Iran. Therefore, we decided to publish it for the first time.

METHODS

This was a prospective cross-sectional study. Data was obtained from 538 patients consecutively enrolled in the Iranian Epidermolysis Bullosa Registry, using a detailed instrument created by burn research center of Iran University of Medical Sciences, Tehran, Iran from Jan 2017 to Sep 2017. Patients' information such as age, gender, address, educational status, parents' family relationship and pathology result were recorded. Then a physician examined patients focusing on gastrointestinal system, teeth, ophthalmologic disorders, psychological problems and contracture of the upper and lower limbs and any other complaint. Data entered SPSS ver.19 and analyzed using ANOVA and LSD tests.

RESULTS

Overall, 538 EB patients were registered in Iran (6.72 patient in 100.000 person) with an approximately equal ratio between males and females. Among 103 patients whose disease type was determined by a pathologist, 78 patients (75.7%) had dystrophic type, 13 (12.6%) junctional, 9 (8.7%) simplex and 3 (2.9%) kindler type. The most common complaint of patients was dysphagia followed by tooth damage.

CONCLUSION

We stablished a data registry for EB patients for the first time in Iran. The frequency of EB in Iran is less than many other countries. However, data completion is to be done to include all patients as possible.

Development of a diagnostic algorithm identifying cases of dislocation after primary total hip arthroplasty-based on 31,762 patients from the Danish Hip Arthroplasty Register

Background and purpose - Dislocation of total hip arthroplasties (THA) is often treated with closed reduction and traditionally not registered in orthopedic registers. This study aimed to create an algorithm designed to identify cases of dislocations of THAs with high sensitivity, specificity, and positive predictive value (PPV) based on codes from the Danish National Patient Register (DNPR).Patients and methods - All patients (n = 31,762) with primary osteoarthritis undergoing THA from January 1, 2010 to December 31, 2014 were included from the Danish Hip Arthroplasty Register (DHR). We extracted available data for every hospital contact in the DNPR during a 2-year follow-up period, then conducted a comprehensive nationwide review of 5,096 patient files to register all dislocations and applied codes.Results - We identified 1,890 hip dislocations among 1,094 of the included 31,762 THAs. More than 70 different diagnoses and 55 procedural codes were coupled to the hospital contacts with dislocation. A combination of the correct codes produced a sensitivity of 63% and a PPV of 98%. Adding alternative and often applied codes increased the sensitivity to 91%, while the PPV was maintained at 93%. Additional steps increased sensitivity to 95% but at the expense of an unacceptable decrease in the PPV to 82%. Specificity was, in all steps, greater than 99%.Interpretation - The developed algorithm achieved high and acceptable values for sensitivity, specificity, and predictive values. We found that surgeons in most cases coded correctly. However, the codes were not always transferred to the discharge summary. In perspective, this kind of algorithm may be used in Danish quality registers.

Validity of First-Time Diagnoses of Inherited Ichthyosis in the Danish National Patient Registry and the Danish Pathology Registry

Purpose

Inherited ichthyosis is a monogenetic disease characterized by hyperkeratosis and scaling of the skin, with large interindividual variation in severity. It can affect quality of life for patients and their families. Population-based data on inherited ichthyosis are lacking, which hampers studies into its epidemiology.

Patients and Methods

Based on medical record review, we validated diagnoses of inherited ichthyosis in two nationwide population-based registries commonly used for epidemiological research: The Danish National Patient Registry and the Danish Pathology Registry. The study period was January 1, 1977, through December 31, 2015. Validation samples were taken from one regional hospital without a specialized dermatological department and two specialized dermatological departments. Positive predictive values (PPVs) were estimated overall and for each coding system (ICD-8, ICD-10 and SNOMED), including for specific ICD-10 codes.

Results

We identified 1772 first-time diagnoses of inherited ichthyosis; 363 patients were diagnosed at the departments selected for validation, and 307 of these patients (84.6%) had medical records enabling validation. We observed an overall PPV of 73.3% (95% CI: 68.1-77.9). For ICD-8, ICD-10, and SNOMED diagnoses, the PPVs were 73.2% (95% CI: 58.1-84.3), 74.7% (95% CI: 69.0-79.7), and 46.2% (95% CI: 22.1-71.7), respectively. In analyses for ICD-10 diagnoses, we observed much higher validity of diagnoses from the specialized departments (PPV 79.7%; 95% CI: 74.1-84.3) than the regional hospital (PPV 5.9%; 95% CI: 0.6-24.3). The PPVs for specific diagnoses were 80.1% for ichthyosis vulgaris and 96.6% for X-linked ichthyosis but below 45% for remaining, rarer, subtypes.

Conclusion

The PPV of first-time diagnosis of inherited ichthyosis made at specialized dermatological departments in the Danish National Patient Registry is approximately 80%. Diagnoses from the Danish Pathology Registry had low PPVs precluding their use for research.