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Surveillance of severe acute respiratory infections associated with SARS-CoV-2, influenza virus and RSV using ICD-10 codes: a case definition accuracy study across five European countries, 2021 to 2023

2025-07Artigo científico Acesso aberto
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datacite.subject.fosCiências Médicas::Ciências da Saúde
datacite.subject.sdg03:Saúde de Qualidade
dc.contributor.authorSanchez Ruiz, Miguel Angel
dc.contributor.authorMarques, Diogo Fp.
dc.contributor.authorLomholt, Frederikke Kristensen
dc.contributor.authorVestergaard, Lasse Skafte
dc.contributor.authorMonge, Susana
dc.contributor.authorLozano Álvarez, Marcos
dc.contributor.authorAspelund, Gudrun
dc.contributor.authorThordardottir, Marianna
dc.contributor.authorDziugyte, Ausra
dc.contributor.authorCauchi, John-Paul
dc.contributor.authorBoere, Tjarda M.
dc.contributor.authorVeldhuijzen, Irene K.
dc.contributor.authorSeppälä, Elina
dc.contributor.authorBøås, Håkon
dc.contributor.authorPaulsen, Trine Hessevik
dc.contributor.authorMachado, Ausenda
dc.contributor.authorRodrigues, Ana Paula
dc.contributor.authorHooiveld, Mariette
dc.contributor.authorAlves de Sousa, Luis
dc.contributor.authorTorres, Ana
dc.contributor.authorCarvalho, Carlos
dc.contributor.authorNunes, Baltazar
dc.date.accessioned2026-01-29T12:40:58Z
dc.date.available2026-01-29T12:40:58Z
dc.date.issued2025-07
dc.description.abstractBackgrounds: Surveillance of severe acute respiratory infections (SARI) using ICD-10 codes from electronic health records (EHR) lacks consensus on optimal case-defining codes.AIMWe determined codes that maximise sensitivity (Se) and positive predictive value (PPV) for SARI associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), influenza virus and respiratory syncytial virus (RSV) in Denmark, Iceland, Malta, Norway and Spain.METHODSWe included hospitalisations from week 21/2021 to 39/2023, with ICD-10 diagnostic codes for respiratory disease (three-character codes J00-J99) or COVID-19 (U07.1, U07.2, country-specific codes for Denmark). We assessed Se and PPV of individual codes against laboratory results. Based on Se and PPV rank-sum, we selected the top 10 codes and combined them into 10 sets per pathogen. We identified sets that maximised the clinical utility index (CUI = Se × PPV), categorised as excellent (≥ 0.81), good (0.64-0.80), satisfactory (0.49-0.63) and poor (< 0.49).RESULTSWe assessed 395,163 hospitalisations for SARI-SARS-CoV-2, 313,418 for SARI-influenza and 192,936 for SARI-RSV, all tested. For SARI-SARS-CoV-2, code U07.1 (B34.2A, B97.2A for Denmark) had excellent utility in Denmark, Malta, Norway, Spain (≥ 0.82), and good utility in Iceland (0.79). For SARI-influenza, J09, J10 and J11 performed excellently in Denmark, Norway, Spain (≥ 0.83), satisfactorily in Malta (0.52), and poorly in Iceland (0.43). For SARI-RSV, J12, J20 and J21 achieved highest CUI but had poor utility (0.17-0.34).CONCLUSIONSCOVID-19- and influenza-specific three-character ICD-10 codes accurately identified SARI associated with SARS-CoV-2 and influenza virus. For SARI-RSV, four-character codes should be explored. We recommend context-specific assessments in countries adopting EHR-based surveillance.por
dc.description.sponsorshipDesign and implementation of multinational surveillance systems using routinely collected electronic health records in EU/EEA”, funded by the European Centre for Disease Prevention and Control through a service contract with Epiconcept (specific contract No 3 ECD.14898 ID26495 - implementing framework contract ECDC/2022/003)
dc.identifier.citationEuro Surveill. 2025 Jul;30(27):2400748. doi: 10.2807/1560-7917.ES.2025.30.27.2400748
dc.identifier.doi10.2807/1560-7917.ES.2025.30.27.2400748
dc.identifier.issn1560-7917
dc.identifier.pmid40642769
dc.identifier.urihttp://hdl.handle.net/10400.18/10785
dc.language.isoeng
dc.peerreviewedyes
dc.publisherEuropean Centre for Disease Prevention and Control
dc.relation.hasversionhttps://www.eurosurveillance.org/content/10.2807/1560-7917.ES.2025.30.27.2400748
dc.rights.urihttp://creativecommons.org/licenses/by/4.0/
dc.subjectElectronic Health Records
dc.subjectInfluenza – Human
dc.subjectInternational Classification of Diseases
dc.subjectRespiratory Syncytial Virus – Human
dc.subjectSARS-CoV-2
dc.subjectSurveillance
dc.subjectEstados de Saúde e de Doença
dc.subjectObservação em Saúde e Vigilância
dc.subjectInfecções Respiratórias
dc.titleSurveillance of severe acute respiratory infections associated with SARS-CoV-2, influenza virus and RSV using ICD-10 codes: a case definition accuracy study across five European countries, 2021 to 2023por
dc.typejournal article
dspace.entity.typePublication
oaire.citation.issue27
oaire.citation.startPage2400748
oaire.citation.titleEurosurveillance
oaire.citation.volume30
oaire.versionhttp://purl.org/coar/version/c_970fb48d4fbd8a85
person.familyNameMachado
person.familyNameRodrigues
person.givenNameAusenda
person.givenNameAna Paula
person.identifier.ciencia-id1217-6076-5D88
person.identifier.orcid0000-0002-1849-1499
person.identifier.orcid0000-0003-2264-4723
relation.isAuthorOfPublication544ad266-0c22-4a50-9ebc-86acc08d6666
relation.isAuthorOfPublicationc23c6d96-e605-424f-abbb-64d783c73939
relation.isAuthorOfPublication.latestForDiscoveryc23c6d96-e605-424f-abbb-64d783c73939

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