Local Validation of a National Orthopaedic Registry.

BACKGROUND/OBJECTIVE: Registries are limited by the quality of the data they collect. We aimed to measure the data entry error rate at a regional orthopaedic unit in a national arthroplasty registry and to assess a proposed intervention of restricting data entry to senior trainees. METHODS AND MATERIALS: A total of 200 primary and revision arthroplasty cases (119 hips, 81 knees) were randomly selected from a single year, 2020. The Irish National Orthopaedic Registry was examined for the grade of the trainee that populated the form and the accuracy of 24 parameters by comparison with data recorded elsewhere in the patient record. RESULTS: The mean number of errors per form was 2.17 (95% confidence interval (CI): 1.95-2.39), giving an overall error rate of 9% (95% CI: 8%-10.0%). Eighty-seven percent of forms examined contained inaccuracies, ranging from one to nine errors (4%-38%). Some parameters were more prone to errors, ranging from 1% to 28%. There was no evidence of total errors varying by trainee grade (analysis of variance (ANOVA) p-value: 0.34). CONCLUSIONS: Error rates were in line with the literature. Results did not support restricting data entry to senior trainees.

Giant Left Ventricular Papillary Fibroelastoma Presented as Transient Ischemic Attack and Complicated by Post-Pericardiotomy Syndrome.

Papillary fibroelastoma is a benign cardiac tumour that most commonly presents as an incidental finding on imaging but may present with an acute neurological event due to embolic phenomena. We report a 51-year-old female who presented with focal neurology of the right hand that lasted for 30 minutes. Her initial investigations including CT-brain were unremarkable, and given her low-risk profile for stroke she was discharged for routine outpatient workup of possible transient ischaemic attack. Transthoracic echo detected a large mobile mass attached to the left ventricular wall. This was mistakenly diagnosed as a left ventricular thrombus, for which she was commenced on warfarin. After three months on warfarin without reduction in the size of the mass, cardiac MRI was performed. The scan was repeated as the initial imaging failed to demonstrate the tumour. This was followed by positron emission tomography which suggested a benign mass of the left ventricle. The patient underwent surgical excision of the tumour and developed post-pericardiotomy syndrome. Histopathology confirmed papillary fibroelastoma. Though rare, cardiac neoplasm may remain a differential diagnosis for acute neurological presentations in non-classical patients.