[Data validity in a French diagnosis-related group information program]. / Validité de la description d'un groupe spécifique de patients par le PMSI-SSR.

BACKGROUND: Long-term intratracheal ventilated patients need continuous artificial ventilation support. After the acute periods, these patients may benefit from dedicated follow-up in rehabilitation care centers. In this paper, we aimed to study the validity of the data provided by a French diagnosis-related group (DRG) information system. METHODS: For a sample of intratracheal ventilated patients in two rehabilitation units, we compared the data provided in the DRG information system with the data available in the medical charts. Furthermore, we asked the medical, nursing and allied health staff to assess the data provided by the French DRG information system. RESULTS: The diagnosis was found accurate for 86% of hospital stays. In the DRG information system, 77% of the medical care, and 39% of the nursing and allied health care were mentioned correctly. Overall, 55% of the nursing and allied health care procedures in the DRG information system were not reported in the medical charts. The healthcare providers estimated that the frequency of the care provided was underestimated in the DRG information system for 30% of the nursing and allied health care. CONCLUSION: The patients' main characteristics were found correctly reported in the DRG information system. However, the diversity and the frequency of the care provided were underestimated. These underestimates were mainly related to care frequently provided in these patients (for example, urinary catheterization, massages, counseling for relatives).

[Primary arthritis of the hip in adults]. / Arthrites primitives de hanche de l'adulte.

Between 1950 and 1991 the authors have treated 45 adults with primary septic arthritis of the hip, not including tuberculosis. The mortality rate was 13%. There is an accompanying septicaemia, or, more commonly, a bacteraemia, and other general and local factors are often present. The diagnosis may be obvious, but in 50% of cases the presentation may be atypical and the clinical diagnosis uncertain. Confirmation of the diagnosis is by a positive culture from the aspirate, and a Staphylococcus is the usual organism found. The various methods of management used are discussed and the literature analyzed. Wide drainage of the hip is recommended. Arthrodesis is now rarely necessary, and a total replacement arthroplasty may be undertaken when the infection has been controlled. Six out of seven such procedures carried out in their unit in the last 10 years have been successful.

[Salter's single-stage bilateral pelvic osteotomy]. / L'ostéotomie pelvienne de Salter bilatérale en un temps opératoire.

45 children (3 years 9 months old in average), suffering from congenital dislocation of the hip or acetabular dysplasia have sustained a bilateral innominate osteotomy in a single stage. Two different operative procedures have been used: "simultaneous osteotomy" (15 children) and "successive osteotomy" (30 children). The post-operative follow-up lasted 4 years 3 months. On both sides, the correction of acetabular deformity was obtained, the average value of the acetabular angle which was 36.6 in a pre-operative state, being 17.1 post-operative and 11.5 at the last follow-up. Complications were rare (3 superficial infections, 1 Kirschner wires migration and 2 hip instabilities which called for a capsulorraphy). The results were excellent for 83 hips, fair for 3 hips in 3 children (asymmetrical shift of the osteotomy) and poor for 4 hips in 3 children (who were contraindications of the Salter's osteotomy). The authors conclude that one-step bilateral innominate osteotomy is viable and simple. It makes a second operation unnecessary and results in a better angular gain compared to that obtained after unilateral osteotomy.