tetano
Editor, Senior Moderator
Clin Microbiol Infect. 2018 Jun 12. pii: S1198-743X(18)30458-0. doi: 10.1016/j.cmi.2018.05.023. [Epub ahead of print]
[h=1]Are we missing respiratory viral infections in infants and children? Comparison of a hospital-based quality management system with standard of care.[/h] Alchikh M[SUP]1[/SUP], Conrad T[SUP]2[/SUP], Hoppe C[SUP]3[/SUP], Ma X[SUP]4[/SUP], Broberg E[SUP]5[/SUP], Penttinen P[SUP]6[/SUP], Reiche J[SUP]7[/SUP], Biere B[SUP]8[/SUP], Schweiger B[SUP]9[/SUP], Rath B[SUP]10[/SUP].
[h=3]Author information[/h]
[h=3]Abstract[/h] [h=4]OBJECTIVES:[/h] Hospital-based surveillance of influenza and acute respiratory infections relies on ICD-codes and hospital laboratory reports (Standard-of-Care). It is unclear how many cases are missed with either method, i.e. remain undiagnosed/coded as influenza and other respiratory virus infections. Various influenza-like illness (ILI) definitions co-exist with little guidance on how to use them. We are comparing the diagnostic accuracy of standard surveillance methods with a prospective quality management (QM-Program) at a Berlin children's hospital with the Robert-Koch-Institute (RKI).
[h=4]METHODS:[/h] Independent from routine care, all patients fulfilling pre-defined ILI-criteria (QM-ILI) participated in the QM-Program: A separate QM-team conducted standardized clinical assessments and collected nasopharyngeal specimens for blinded real-time qPCR for influenza A/B, respiratory syncytial virus, adenovirus, rhinovirus and human metapneumovirus.
[h=4]RESULTS:[/h] Among 6073 ILI-patients qualifying for the QM-Program, only 8.7% (528/6073) would have undergone virus diagnostics during Standard-of-Care. Surveillance based on ICD-codes would have missed 61%(359/587) of influenza diagnoses. 53.2%(2811/5282) of baseline ICD-codes were non-specific, most commonly J06 ("acute upper respiratory infection"). Comparison of stakeholder case definitions revealed that QM-ILI and the WHO_ILI case definition showed the highest overall sensitivities (84-97% and 45-68%, respectively) and the CDC_ILI definition the highest sensitivity for influenza infections (36% (CI 31.4,40.8) for influenza A and 48% (CI 40.5,54.7) for influenza B).
[h=4]CONCLUSIONS:[/h] Disease-burden estimates and surveillance should account for the underreporting of cases in routine care. Future studies should explore the effect of ILI-screening and surveillance in various age groups and settings. Diagnostic algorithms could be based on the WHO ILI definition combined with targeted testing.
Copyright ? 2018 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.
[h=4]KEYWORDS:[/h] ICD-coding; Influenza-like illness; case definitions; children; diagnostics; influenza; quality management; respiratory viruses
PMID: 29906596 DOI: 10.1016/j.cmi.2018.05.023
[h=1]Are we missing respiratory viral infections in infants and children? Comparison of a hospital-based quality management system with standard of care.[/h] Alchikh M[SUP]1[/SUP], Conrad T[SUP]2[/SUP], Hoppe C[SUP]3[/SUP], Ma X[SUP]4[/SUP], Broberg E[SUP]5[/SUP], Penttinen P[SUP]6[/SUP], Reiche J[SUP]7[/SUP], Biere B[SUP]8[/SUP], Schweiger B[SUP]9[/SUP], Rath B[SUP]10[/SUP].
[h=3]Author information[/h]
[h=3]Abstract[/h] [h=4]OBJECTIVES:[/h] Hospital-based surveillance of influenza and acute respiratory infections relies on ICD-codes and hospital laboratory reports (Standard-of-Care). It is unclear how many cases are missed with either method, i.e. remain undiagnosed/coded as influenza and other respiratory virus infections. Various influenza-like illness (ILI) definitions co-exist with little guidance on how to use them. We are comparing the diagnostic accuracy of standard surveillance methods with a prospective quality management (QM-Program) at a Berlin children's hospital with the Robert-Koch-Institute (RKI).
[h=4]METHODS:[/h] Independent from routine care, all patients fulfilling pre-defined ILI-criteria (QM-ILI) participated in the QM-Program: A separate QM-team conducted standardized clinical assessments and collected nasopharyngeal specimens for blinded real-time qPCR for influenza A/B, respiratory syncytial virus, adenovirus, rhinovirus and human metapneumovirus.
[h=4]RESULTS:[/h] Among 6073 ILI-patients qualifying for the QM-Program, only 8.7% (528/6073) would have undergone virus diagnostics during Standard-of-Care. Surveillance based on ICD-codes would have missed 61%(359/587) of influenza diagnoses. 53.2%(2811/5282) of baseline ICD-codes were non-specific, most commonly J06 ("acute upper respiratory infection"). Comparison of stakeholder case definitions revealed that QM-ILI and the WHO_ILI case definition showed the highest overall sensitivities (84-97% and 45-68%, respectively) and the CDC_ILI definition the highest sensitivity for influenza infections (36% (CI 31.4,40.8) for influenza A and 48% (CI 40.5,54.7) for influenza B).
[h=4]CONCLUSIONS:[/h] Disease-burden estimates and surveillance should account for the underreporting of cases in routine care. Future studies should explore the effect of ILI-screening and surveillance in various age groups and settings. Diagnostic algorithms could be based on the WHO ILI definition combined with targeted testing.
Copyright ? 2018 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.
[h=4]KEYWORDS:[/h] ICD-coding; Influenza-like illness; case definitions; children; diagnostics; influenza; quality management; respiratory viruses
PMID: 29906596 DOI: 10.1016/j.cmi.2018.05.023