Sanchez Ruiz Miguel Angel, Marques Diogo Fp, Lomholt Frederikke Kristensen, Vestergaard Lasse Skafte, Monge Susana, Lozano Álvarez Marcos, Aspelund Gudrun, Thordardottir Marianna, Dziugyte Ausra, Cauchi John-Paul, Boere Tjarda M, Veldhuijzen Irene K, Seppälä Elina, Bøås Håkon, Paulsen Trine Hessevik, Machado Ausenda, Rodrigues Ana Paula, Hooiveld Mariette, Alves de Sousa Luis, Torres Ana, Carvalho Carlos, Nunes Baltazar
Epiconcept, Paris, France.
Department of Infectious Disease Epidemiology and Prevention, Statens Serum Institut, Copenhagen, Denmark.
Euro Surveill. 2025 Jul;30(27). doi: 10.2807/1560-7917.ES.2025.30.27.2400748.
BACKGROUNDSurveillance 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.
背景
利用电子健康记录（EHR）中的国际疾病分类第十版（ICD - 10）编码对严重急性呼吸道感染（SARI）进行监测，在最佳病例定义编码方面缺乏共识。
目的
我们确定了在丹麦、冰岛、马耳他、挪威和西班牙，能使与严重急性呼吸综合征冠状病毒2（SARS-CoV-2）、流感病毒和呼吸道合胞病毒（RSV）相关的SARI的敏感性（Se）和阳性预测值（PPV）最大化的编码。
方法
我们纳入了2021年第21周（即2021年5月17日 - 2021年5月23日）至2023年第39周（即2023年9月25日 - 2023年10月1日）的住院病例，这些病例具有呼吸道疾病（三位编码J00 - J99）或COVID-19（U07.1、U07.2，丹麦的特定国家编码）的ICD - 10诊断编码。我们根据实验室结果评估各个编码的Se和PPV。基于Se和PPV的秩和，我们选择了前10个编码，并针对每种病原体将它们组合成10组。我们确定了使临床效用指数（CUI = Se × PPV）最大化的组，分为优秀（≥ 0.81）、良好（0.64 - 0.80）、满意（0.49 - 0.63）和差（< 0.49）四类。
结果
我们评估了395,163例SARI - SARS-CoV-2住院病例、313,418例SARI - 流感住院病例和192,936例SARI - RSV住院病例，所有病例均经过检测。对于SARI - SARS-CoV-2，编码U07.1（丹麦为B34.2A、B97.2A）在丹麦、马耳他、挪威、西班牙具有优秀的效用（≥ 0.82），在冰岛具有良好的效用（0.79）。对于SARI - 流感，J09、J10和J11在丹麦、挪威、西班牙表现优秀（≥ 0.83），在马耳他表现满意（0.52），在冰岛表现较差（0.43）。对于SARI - RSV，J12、J20和J21的CUI最高，但效用较差（0.17 - 0.34）。
结论
针对COVID - 19和流感的ICD - 10三位编码能够准确识别与SARS-CoV-2和流感病毒相关的SARI。对于SARI - RSV，应探索四位编码。我们建议在采用基于EHR监测的国家进行针对具体情况的评估。
