Improving identification of idiopathic intracranial hypertension patients in Swedish patient register.

OBJECTIVE: Idiopathic intracranial hypertension (IIH) is often misdiagnosed. This can cause problems if conducting register-based studies. The study purpose was to produce algorithms that better identify patients with correct diagnosis of IIH in the Swedish National Patient Register (NPR). METHODS: Patients with ICD-10 code G93.2 for IIH registered in the NPR (2006-2013, Stockholm County) were included and diagnosis validated by medical record reviews. Patients were randomized into two groups: one used to produce the algorithm (n = 105) and one for validation (n = 102). We tested variables possible to extract from registries and used forward stepwise logistic regression which provided a predicted probability of correct diagnosis for each patient. RESULTS: We included 207 patients of which 135 had confirmed IIH. This gave a positive predictive value of 65.2% (CI: 58.4-71.4). The algorithm produced with variables extracted from registries, that is, age, number of times with diagnosis code G93.2 recorded (>2 times), and acetazolamide treatment, predicted the diagnosis correctly 88.2% (CI: 80.3-93.3) of the time. Excluding treatment data from the algorithm did not change the prediction notably, 86.3% (CI: 78.1-91.7). CONCLUSION: We produced two algorithms that with improved accuracy predict whether an IIH diagnosis in the NPR is correct. This can be a useful tool when performing register-based studies.

Population-based incidence and clinical characteristics of idiopathic intracranial hypertension.

OBJECTIVE: To validate the diagnosis of idiopathic intracranial hypertension (IIH) from the Swedish National Patient Register (NPR) and investigate the incidence of IIH, as well as co-morbidities and medication use in a large Swedish population-based sample. METHODS: We searched the NPR to find all patients ≥18 years old with the ICD-10 diagnosis code (G93.2) for IIH in Stockholm County from Jan 1, 2006, to Dec 31, 2013. All medical records were reviewed to validate the diagnosis and to collect additional information. RESULTS: We included 207 patients with an IIH diagnosis, of which 135 (65%) were correctly diagnosed when validated by charts review. Eighty-three patients had disease onset during the study period. This gave a yearly incidence of 0.65/100 000. Female-to-male ratio was 6.1:1. Females, mean age 31.0 (CI 28.8-33.1), were younger at time of diagnosis compared to males, mean age 42.9 (CI 36.4-49.5), P<.001. The most common co-morbidities were obesity (92%), hormonal conditions (21%) and recent infections preceding the diagnosis (21%). Prior treatment with tetracycline derivatives were seen in 9%. CONCLUSION: The incidence of IIH in Stockholm is in the lower range of previously reported rates, possibly due to a lower prevalence of obesity. A substantial proportion of patients (35%) did not fulfill diagnostic criteria. Disease onset occurs at younger age in females. Co-morbidities were mainly associated with diseases affecting hormonal balance or causing inflammatory activation. These findings raise new hypothetical theories regarding mechanisms involved in IIH pathogenesis.

Immobilization after primary dislocation of the shoulder.

A total of 226 patients with primary shoulder dislocation were followed up for 1 year, the primary object being to observe the effect of immobilization on the incidence of redislocation. The shoulders were immobilized in a mitella for 1 week in all the 127 patients older than 50 years of age, and in 53 of the patients under 50 years of age. The shoulders of the remaining 46 patients (under 50 years) were completely immobilized with a stockinette-Gilchrist bandage for a period of 3 weeks. Thirteen per cent (30/226) suffered from one to four redislocations each during the follow-up period. Because most recurrences occurred in the patients under 30 years of age, these patients were compared with the older ones in the analysis. The frequency of redislocation was higher in the group of 53 patients under 30 years than in the older subgroup (P less than 0.001). Twenty-six of these 53 patients (under 30 years), who had been immobilized for 1 week, presented a higher frequency of redislocation than the remaining 27 patients subjected to 3 weeks' immobilization (P less than 0.05). Manual labourers experienced more numerous redislocations than office workers (P less than 0.01). The greater the initial trauma to the shoulder, the lower was the incidence of recurrence. There were only two among the 57 patients with early complications of the primary shoulder dislocation who had a redislocation (P less than 0.001). Residual stiffness was encountered more often in the patients over 30 years than in the younger ones (P less than 0.001). Following primary shoulder dislocation, 1 week's immobilization in a sling is sufficient in patients over 30 years, while in the case of most of the younger patients 3 weeks' complete immobilization of the shoulder is recommended.

Pulsating shortwave diathermy: value in treatment of recent ankle and foot sprains.

The effects of 2 pulsating shortwave diathermy treatments (Diapulse and Curapuls) were compared with placebo treatment in recent ligamentous injuries of ankle and foot in 300 outpatients. The areas of comparison were reduction in swelling, recovery of strength and range of motion of the injured ankle, improvement of walking ability, and duration of disability. There were only slight differences between Diapulse and Curapuls treatment groups. No statistically significant differences could be observed in the recovery of strength and range of motion or in the duration of disability among the 3 groups, although walking ability in the Diapulse group recovered better than in the placebos (p less than 0.01) and reduction of swelling was significantly better for Curapuls (p less than 0.001 than for placebos.

Early complications of primary shoulder dislocations.

A prospective study of the complications of primary shoulder dislocation was carried out for the 3-year period 1973-1976. The clinical examination was made initially in the Casualty Department and the patient was re-examined in the Department of Physical Medicine. In the evaluation special attention was given to the condition of the rotator cuff, the blood vessels and the motor and sensory function of the affected extremity. Sixty-three out of 238 patients (26 per cent) presented with the following complications: 29 lesions of the brachial plexus, 21 of the axillary nerve and 28 ruptures of the rotator cuff tendon. Complications occurred more frequently in the age group over 50 years (P less than 0.001) and in manual labourers compared with office workers (P less than 0.05). If the humerus remained unreduced for more than 12 hours, the frequency of complications increased (P less than 0.01).