The National Joint Registry (NJR) was set up by the Department of Health to collect information on all joint replacements. The NJR data is externally validated against nationally collated Hospital Episode Statistics (HES). Errors associated with the use of HES data have been widely documented. We sought to explore the accuracy of the NJR data, for a single surgeon, against a prospectively collected personal logbook. The NJR and logbook were compared over a 3-year period (01/07/2009 to 30/06/2012). Total procedure recorded in the personal logbook was 684 and in the NJR was 681. TKR in personal log book was 304 and in NJR 316, revision knee's in personal logbook 45 and in NJR 36, THR 274 in personal logbook and 271 in NJR, revision hip procedures in personal logbook 64 and 58 in NJR. Whilst the total number of procedures captured correlates closely (681 vs 684) there is more variation with the different individual procedures. This may be due to the addition of 11% of HES data used for this time period by the NJR as it is known to be inaccurate. This therefore demonstrates the importance of maintaining your own accurate records.
Establishing the diagnosis in a child presenting with an atraumatic limp can be difficult. Clinical prediction algorithms have been devised to distinguish septic arthritis (SA) from transient synovitis (TS). Within Europe measurement of the Erythrocyte Sedimentation Rate (ESR) has largely been replaced with assessment of C-Reactive Protein (CRP) as an acute phase protein. We produce a prediction algorithm to determine the significance of CRP in distinguishing between TS and SA. All children with a presentation of ‘atraumatic limp’ and a proven effusion on hip ultrasound between 2004 and 2009 were included. Patient demographics, details of the clinical presentation and laboratory investigations were documented to identify a response to each of the four variables (Weight bearing status, WCC >12,000 cells/m3, CRP >20mg/L and Temperature >38.5°C). SA was defined based upon culture and microscopy of the operative findings.Background
Method