Symptom-based case definitions for COVID-19: Time and geographical variations for detection at hospital admission among 260,000 patients.
Symptom-based case definitions for COVID-19: Time and geographical variations for detection at hospital admission among 260,000 patients.
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DOI：
10.1111/irv.13039
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发表时间：
2022-11
影响因子：
4.4
通讯作者：
Olliaro, Piero
中科院分区：
文献类型：
--
作者：
Baruch, Joaquin;Rojek, Amanda;Kartsonaki, Christiana;Vijayaraghavan, Bharath K. T.;Goncalves, Bronner P.;Pritchard, Mark G.;Merson, Laura;Dunning, Jake;Hall, Matthew;Sigfrid, Louise;Citarella, Barbara W.;Murthy, Srinivas;Yeabah, Trokon O.;Olliaro, Piero
病例定义用于指导临床实践、监测和研究方案。然而，它们如何识别因新冠病毒感染住院的患者尚未完全明确。我们在国际严重急性呼吸系统和新发感染联盟（ISARIC）前瞻性队列研究数据库中，分析了符合广泛使用的病例定义的实验室确诊新冠病毒感染住院患者的比例。
按照年龄、地区和时间，使用美国疾病控制中心（CDC）、欧洲疾病预防控制中心（ECDC）、世界卫生组织（WHO）以及英国卫生安全局（UKHSA）的病例定义对患者进行评估。对符合和不符合病例定义的患者的病死率（CFR）以及症状进行评估。排除数据不完整以及无实验室确诊检测结果的患者。
ISARIC数据库中共有263218名患者（42%）被纳入研究。大多数患者（90.4%）来自欧洲和中亚。符合病例定义的患者比例分别为：世界卫生组织（WHO）56.8%、英国卫生安全局（UKHSA）74.4%、欧洲疾病预防控制中心（ECDC）81.6%、美国疾病控制中心（CDC）82.3%。对于每个病例定义，年龄分布两端的患者符合标准的频率低于30岁至70岁的患者；还观察到地域和时间差异。符合病例定义的患者估计病死率相似。然而，当更多患者不符合病例定义时，病死率会上升。
病例定义的效果在不同地区可能不同，并且可能随时间变化。同样令人担忧的是，老年患者往往不符合病例定义，存在延误医疗救治的风险。虽然流行病学家必须在分析与现场适用性之间取得平衡，但有必要不断修订病例定义，以便通过早期诊断改善患者护理并限制潜在的医院内传播。
Case definitions are used to guide clinical practice, surveillance and research protocols. However, how they identify COVID‐19‐hospitalised patients is not fully understood. We analysed the proportion of hospitalised patients with laboratory‐confirmed COVID‐19, in the ISARIC prospective cohort study database, meeting widely used case definitions. Patients were assessed using the Centers for Disease Control (CDC), European Centre for Disease Prevention and Control (ECDC), World Health Organization (WHO) and UK Health Security Agency (UKHSA) case definitions by age, region and time. Case fatality ratios (CFRs) and symptoms of those who did and who did not meet the case definitions were evaluated. Patients with incomplete data and non‐laboratory‐confirmed test result were excluded. A total of 263,218 of the patients (42%) in the ISARIC database were included. Most patients (90.4%) were from Europe and Central Asia. The proportions of patients meeting the case definitions were 56.8% (WHO), 74.4% (UKHSA), 81.6% (ECDC) and 82.3% (CDC). For each case definition, patients at the extremes of age distribution met the criteria less frequently than those aged 30 to 70 years; geographical and time variations were also observed. Estimated CFRs were similar for the patients who met the case definitions. However, when more patients did not meet the case definition, the CFR increased. The performance of case definitions might be different in different regions and may change over time. Similarly concerning is the fact that older patients often did not meet case definitions, risking delayed medical care. While epidemiologists must balance their analytics with field applicability, ongoing revision of case definitions is necessary to improve patient care through early diagnosis and limit potential nosocomial spread.
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影响因子：
7.5
作者：
ISARIC Clinical Characterisation Group
通讯作者：
ISARIC Clinical Characterisation Group
DOI：
10.1016/s2589-7500(21)00272-7
发表时间：
2022-04
期刊：
The Lancet. Digital health
影响因子：
--
作者：
Soltan AAS;Yang J;Pattanshetty R;Novak A;Yang Y;Rohanian O;Beer S;Soltan MA;Thickett DR;Fairhead R;Zhu T;Eyre DW;Clifton DA;CURIAL Translational Collaborative
通讯作者：
CURIAL Translational Collaborative
影响因子：
105.7
作者：
Docherty, Annemarie B.;Harrison, Ewen M.;Semple, Malcolm G.
通讯作者：
Semple, Malcolm G.
影响因子：
11.8
作者：
Suthar AB;Schubert S;Garon J;Couture A;Brown AM;Charania S
通讯作者：
Charania S
影响因子：
50
作者：
Tsang, Tim K.;Wu, Peng;Cowling, Benjamin J.
通讯作者：
Cowling, Benjamin J.