Bierrenbach Ana Luiza, Ranzani Olivia Tavares
Precision Data, São Paulo, São Paulo, Brazil.
Instituto de Ensino e Pesquisa, Hospital Sírio-Libanês, São Paulo, São Paulo, Brazil.
PLoS One. 2025 Mar 28;20(3):e0319436. doi: 10.1371/journal.pone.0319436. eCollection 2025.
Respiratory Syncytial Virus (RSV) is a leading cause of severe respiratory infections in young children and older adults. Accurate RSV surveillance is essential to understanding its disease burden and evaluating vaccine impact.
We assessed the accuracy of ICD-10 coding for RSV hospitalizations in the Brazilian Hospital Information System (SIH) by linking it with the Severe Acute Respiratory Syndrome (SIVEP) notification system (2022-2023). Laboratory-confirmed RSV-positive and RSV-negative cases in SIVEP were used as the reference standard. Sensitivity and specificity were evaluated for ICD-10 definitions (RSV, RSV + J21 [Acute Bronchiolitis], RSV + Acute Respiratory Infection) overall and by age group (under 1 year, under 5 years, and over 60 years). The top 10 diagnoses of RSV-positive patients were also analyzed by age group.
Among 15,169 RSV-positive patients linked to an SIH record, 73.0% were under 12 months old, 20.8% were 1-5 years old, 3.7% were 5-59 years old, and 2.5% were 60 + years. Acute bronchiolitis was the most common diagnosis overall (43.5%), particularly in infants (53.5%). In older adults, pneumonia due to unspecified microorganisms was most frequent (24.6%). Sensitivity improved with broader case definitions, such as, RSV + Acute Respiratory Infection (66.7%, 95%CI: 65.8-67.6 in infants; 23%, 95%CI: 18.9-27.6 in older adults). Specificity was higher in older adults (83.8%, 95%CI: 83.5-84.1) than in infants (45.1%, 95%CI: 44.4-45.6). Additionally, 40,701 RSV-positive notified cases lacked RSV-coded diagnoses in SIH.
Our study highlights the discrepancy between RSV-positive cases identified in SIVEP and those coded in the SIH database, reflecting limitations in ICD-10 coding, particularly in the older population. Reliance on symptomatic coding rather than confirmed diagnoses contributes to this issue. Accurate RSV identification is crucial, especially with new vaccines available. Improved diagnostic coding is essential for effective RSV surveillance and evaluating vaccine impact.
呼吸道合胞病毒（RSV）是幼儿和老年人严重呼吸道感染的主要病因。准确的RSV监测对于了解其疾病负担和评估疫苗影响至关重要。
我们通过将巴西医院信息系统（SIH）中RSV住院病例的ICD-10编码与严重急性呼吸综合征（SIVEP）通报系统（2022 - 2023年）相链接，评估了ICD-10编码的准确性。SIVEP中实验室确诊的RSV阳性和RSV阴性病例用作参考标准。总体上以及按年龄组（1岁以下、5岁以下和60岁以上）评估了ICD-10定义（RSV、RSV + J21[急性细支气管炎]、RSV + 急性呼吸道感染）的敏感性和特异性。还按年龄组分析了RSV阳性患者的前10种诊断。
在与SIH记录相关联的15,169例RSV阳性患者中，73.0%为12个月以下，20.8%为1 - 5岁，3.7%为5 - 59岁，2.5%为60岁及以上。总体上，急性细支气管炎是最常见的诊断（43.5%），尤其是在婴儿中（53.5%）。在老年人中，未指明微生物所致肺炎最为常见（24.6%）。使用更宽泛的病例定义时敏感性有所提高，例如RSV + 急性呼吸道感染（婴儿中为66.7%，95%CI：65.8 - 67.6；老年人中为23%，95%CI：18.9 - 27.6）。老年人的特异性（83.8%，95%CI：83.5 - 84.1）高于婴儿（45.1%，95%CI：44.4 - 45.6）。此外，40,701例RSV阳性通报病例在SIH中缺乏RSV编码的诊断。
我们的研究突出了SIVEP中确定的RSV阳性病例与SIH数据库中编码病例之间的差异，反映了ICD-10编码的局限性，尤其是在老年人群中。依赖症状编码而非确诊诊断导致了这一问题。准确识别RSV至关重要，特别是在有新疫苗可用的情况下。改进诊断编码对于有效的RSV监测和评估疫苗影响至关重要。
