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Lancet Reg Health Am
. 2025 Feb 21:44:101034.
doi: 10.1016/j.lana.2025.101034. eCollection 2025 Apr. Performance of the World Health Organization (WHO) severe acute respiratory infection (SARI) case definitions in hospitalized children and youth: cross-sectional study
Peter J Gill 1 2 3 4 , Caitlyn L Kaziev 2 , Haifa Mtaweh 2 3 5 , Tuana Kant 6 , Claire Seaton 7 8 9 , Daniel S Farrar 2 10 , Hayley Wagman 3 , Mei Han 11 , Rohini R Datta 10 , Sanjay Mahant 1 2 3 4 , Gabrielle Freire 2 3 12 , Aaron Campigotto 13 14 , Jeffrey N Bone 15 , Manish Sadarangani 9 16 , Francine Buchanan 2 17 , Shaun K Morris 2 3 10 18 19 ; READAPT-Kids Study
Collaborators, Affiliations
Background: Respiratory tract infections with viral pathogens are frequently identified using the World Health Organization (WHO) case definition of severe acute respiratory infection (SARI), defined as fever of ≥38°Celsius, cough, onset within 10 days, and hospitalization. While there is extensive research in adults, less is known about the WHO SARI case definition performance in children and youth. We aimed to determine the performance of the WHO SARI and modified case definitions in identifying viral respiratory tract infections in hospitalized children and youth.
Methods: Retrospective observational cross-sectional study of hospitalized children (0-18 years) with an acute respiratory infection and who received a respiratory viral test at two large Canadian children's hospitals from July 2022 to June 2023. The WHO SARI and modified SARI case definitions were evaluated overall, by virus and age, with reporting of sensitivity and specificity.
Findings: There were 2333 hospital admissions, with a median age of 2.4 years (IQR 0.8-5.0). 78% (n = 1828) had one or more viruses identified, most commonly respiratory syncytial virus (30%, n = 709). The WHO SARI definition had a sensitivity of 58% and specificity of 49% for identifying infections with a microbiologically confirmed virus. For Influenza only, the sensitivity was 71% and specificity 44%. The lowest sensitivity was among young children <3 months (28%) and 3 to <6 months (45%). Modified SARI definitions had similarly poor performance, with trade-offs of sensitivity and specificity.
Interpretation: The widely implemented WHO SARI case definition has sub-optimal performance among children and youth hospitalized with acute respiratory infections. Public health surveillance based on these case definitions may inadequately detect and monitor known and emerging infections, highlighting the need to develop an accurate and reliable SARI case definition for children and youth globally.
Funding: Public Health Agency of Canada, SickKids Foundation, BC Children's Hospital.
Keywords: Case definitions; Children; Diagnostic accuracy; Hospitalization; Paediatrics; Pandemics; Public health; Respiratory viruses; Sensitivity; Severe acute respiratory infections; Specificity; Surveillance; World Health Organization; Youth.
. 2025 Feb 21:44:101034.
doi: 10.1016/j.lana.2025.101034. eCollection 2025 Apr. Performance of the World Health Organization (WHO) severe acute respiratory infection (SARI) case definitions in hospitalized children and youth: cross-sectional study
Peter J Gill 1 2 3 4 , Caitlyn L Kaziev 2 , Haifa Mtaweh 2 3 5 , Tuana Kant 6 , Claire Seaton 7 8 9 , Daniel S Farrar 2 10 , Hayley Wagman 3 , Mei Han 11 , Rohini R Datta 10 , Sanjay Mahant 1 2 3 4 , Gabrielle Freire 2 3 12 , Aaron Campigotto 13 14 , Jeffrey N Bone 15 , Manish Sadarangani 9 16 , Francine Buchanan 2 17 , Shaun K Morris 2 3 10 18 19 ; READAPT-Kids Study
Collaborators, Affiliations
- PMID: 40083965
- PMCID: PMC11904563
- DOI: 10.1016/j.lana.2025.101034
Background: Respiratory tract infections with viral pathogens are frequently identified using the World Health Organization (WHO) case definition of severe acute respiratory infection (SARI), defined as fever of ≥38°Celsius, cough, onset within 10 days, and hospitalization. While there is extensive research in adults, less is known about the WHO SARI case definition performance in children and youth. We aimed to determine the performance of the WHO SARI and modified case definitions in identifying viral respiratory tract infections in hospitalized children and youth.
Methods: Retrospective observational cross-sectional study of hospitalized children (0-18 years) with an acute respiratory infection and who received a respiratory viral test at two large Canadian children's hospitals from July 2022 to June 2023. The WHO SARI and modified SARI case definitions were evaluated overall, by virus and age, with reporting of sensitivity and specificity.
Findings: There were 2333 hospital admissions, with a median age of 2.4 years (IQR 0.8-5.0). 78% (n = 1828) had one or more viruses identified, most commonly respiratory syncytial virus (30%, n = 709). The WHO SARI definition had a sensitivity of 58% and specificity of 49% for identifying infections with a microbiologically confirmed virus. For Influenza only, the sensitivity was 71% and specificity 44%. The lowest sensitivity was among young children <3 months (28%) and 3 to <6 months (45%). Modified SARI definitions had similarly poor performance, with trade-offs of sensitivity and specificity.
Interpretation: The widely implemented WHO SARI case definition has sub-optimal performance among children and youth hospitalized with acute respiratory infections. Public health surveillance based on these case definitions may inadequately detect and monitor known and emerging infections, highlighting the need to develop an accurate and reliable SARI case definition for children and youth globally.
Funding: Public Health Agency of Canada, SickKids Foundation, BC Children's Hospital.
Keywords: Case definitions; Children; Diagnostic accuracy; Hospitalization; Paediatrics; Pandemics; Public health; Respiratory viruses; Sensitivity; Severe acute respiratory infections; Specificity; Surveillance; World Health Organization; Youth.