Diseases, Outcomes And Discharge Help

Disease Names : Disease Terms : Symptom Terms : Disease Groups : ICD10 : Outcomes : Discharged To

Diseases

Most admission records included an initial diagnosis, sometimes more than one. These were often written in abbreviated form, or used one of several synonyms for a particular disease or condition.

Indexes of standard terms have been added to the Small and Special database to make searching for diseases easier. By using the indexes users are not required to anticipate what terms might have been employed in the Registers. The following fields in the database relate to the child’s diagnosis:

Register Disease

Not searchable. This field appears in the Admission Record Display and the downloadable results table. It contains the information on diagnosis as entered in the registers.

Disease Name is a keyword word search which uses an index of standard disease terms.

Disease Group is a classification developed specifically for the project. It groups diseases by the body system affected.

Searches can be conducted on either index, and the combination of the two enables searches to be more narrowly targeted.

The third index, ICD10, is a classification of diseases currently in use in hospitals around the world. It is not advisable to combine the ICD10 index with other disease indexes in a search.

Disease Name

The original entries have been standardised using a list of terms developed specifically for this project.

Search this field using individual keywords or phrases, the search will find records containing either, anywhere in the field. For example:

‘Abscess’ – finds all records containing abscess in the disease name field
‘Abscess hip’ – finds only those records containing the term ‘abscess hip’
‘Hip abscess’ – finds no records as the term ‘hip abscess’ is not used as the standard form.

See Hints for an explanation of how the standard disease terms have been constructed.

Hints

Disease Names: the terms in this field do not represent an hierarchy of diseases, but introduce a standard form of disease terms used in the Registers; Scarlet Fever & Sequela is used for all alternative spellings of Scarlet Fever, such as Sc F, Scarletina, SF etc.

There are over 1,000 unique terms in this field. Many of the terms used reflect specific disease entities, such as scarlet fever or whooping cough, while others are more descriptive, such as ‘abscess of knee’. The Project Team has developed a standard form for both diseases and descriptive symptoms. The following tables list the most frequent diseases and symptoms, together they account for 86% of all records in the database.

Leading Disease Terms in Small and Special

For very specific searches use the exact term in a search, or for less specific search use an element of the term.

The doctors at Great Ormond Street often did not diagnose a specific illness, but described symptoms instead. For instance, knee disease or abscess of groin were common diagnoses.

A naming system has been devised for these symptoms by assigning the ‘symptom term’ first followed by the anatomical site of the problem.

For instance the diagnosis in the Register may be written as ‘knee disease’ or ‘abdominal abscess’ or ‘tumour of femur’ etc. These symptoms or vague disease descriptions have been standardised by identifying first the symptom eg ‘Abscess’ or ‘Tumour’ or ‘Disease’, and adding to that the body part affected. So ‘knee disease’ becomes ‘Disease Knee’, ‘tumour of the femur’, becomes ‘Tumour Femur’ and ‘abdominal abscess’ is ‘Abscess Abdomen’.

The following is a list of the most frequently used symptom-words which can be combined with anatomical sites to narrow searches:

Symptom Terms used in Small and Special

These terms can be used either in broad searches, eg to find all abscesss or all diseases involving enlarged organs, or in narrower searches by adding a qualifying site of the symptom: so knee disease would be searched by using the combined term ‘disease knee’; or enlarged glands, by using that very term.

The Disease Names and Symptoms terms listed above account for over 85% of all records in the database.

Disease Group

Disease group is a classification designed specifically for the Small and Special database and is intended to reflect medical knowledge in the Victorian and Edwardian periods. It categorises diseases according to the body system affected, with the exception of infectious conditions and fevers, which are broken down into Infectious Fevers, Fevers, Parasitic Disease and Tubercular Diseases. The table below lists the groups in alphabetical order and provides a brief definition for each.

Search by selecting the group you are interested in from the drop down menu.

Hint

To narrow your search you can combine ‘Disease Name’ and ‘Disease Group’ together. For instance, if you want to find all children affected by abscesses of the musculoskeletal system:

Disease Name = Abscess
Disease Group = Joints Bones and Muscles.

The resulting records will contain all children admitted with abscesses of this system.

Disease Group Classification

ICD10

The International Classification of Diseases (10th Edition – ICD10) is an ‘international standard in diagnostic classification’ compiled by the World Health Organisation and used by health administrators and epidemiologists around the world. For more information on the classification system see www.who.int/classifications/icd.

ICD10 coding has been applied to the Great Ormond Street patient admission records by an experienced Medical Coder from the hospital, who has coded the diagnoses as closely as possible according to current medical knowledge.

The classification is complex and it is recommended that only those familiar with its structure should use this field for searching the database. Our coder has used, where appropriate, a combination of codes to represent diseases and affected sites.

It is advised that the ICD10 index should not be used in combination with other disease indexes to search the database as the two systems derive from different views of medical knowledge. It is very likely that such a search would result in zero hits.

Following ICD10 convention, Uppercase D following a code indicates this is the main disease (indicated by ‘+’ in the ICD10 classification), uppercase A (* in the ICD10 classification) indicates a site of disease.

For instance ‘caries of the spine’ is coded:

A18.0D for tuberculosis of bones and joints, followed by M49.09A indicating site of disease is the vertebral column.

Searching for ICD10 = A18.0D M49.09A produces all records where spinal caries has been diagnosed. (NB When searching for combined codes such as this it is important to type them as shown above, with no spaces between the code and the A or D, but with a space between the two parts of the code.

Outcomes

In ‘Outcomes’ you can search for the result of a child’s stay in hospital. The Hospital used the following terms: ‘Cured’, ‘Relieved’ ‘Not relieved’ and ‘Died’. Select the outcome from the drop down menu to include in the search.

Discharged To

Some children on discharge from the Hospital at Great Ormond Street did not go home but were sent to other institutions, usually for a period of convalescence. Most went to the Hospital’s own convalescent home, Cromwell House at Highgate (always referred to as Highgate in the database). Some went to other convalescent hospitals, while others went to fever hospitals and some general hospitals. Another group of children were removed from the hospital, by friends or relatives, against the advice of the doctor. This group can be retrieved by using the term ‘Removed against advice’.

Use the drop down list to search on this item.

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