期刊
INFLUENZA AND OTHER RESPIRATORY VIRUSES
卷 16, 期 6, 页码 1040-1050出版社
WILEY
DOI: 10.1111/irv.13039
关键词
case definitions; COVID-19; hospitalisation
资金
- UK Foreign, Commonwealth and Development Office
- Wellcome Trust [215091/Z/18/Z, 205228/Z/16/Z, 220757/Z/20/Z]
- Bill and Melinda Gates Foundation [OPP1209135]
- University of Oxford's COVID-19 Research Response Fund [0009109]
- CIHR Coronavirus Rapid Research Funding Opportunity [OV2170359]
- Sunnybrook Research Institute
- endorsement of the Irish Critical Care-Clinical Trials Group
- Irish Critical Care-Clinical Trials Network at University College Dublin
- Health Research Board of Ireland [CTN-2014-12]
- Rapid European COVID-19 Emergency Response research (RECOVER) [101003589]
- European Clinical Research Alliance on Infectious Diseases (ECRAID) [965313]
- COVID Clinical Management Team, AIIMS, Rishikesh, India
- COVID-19 Clinical Management Team, Manipal Hospital Whitefield, Bengaluru, India
- Cambridge NIHR Biomedical Research Centre
- Groote Schuur Hospital Covid ICU Team
- Liverpool School of Tropical Medicine
- University of Oxford
- Norwegian SARS-CoV-2 Study Team
- Research Council of Norway [312780]
- Vivaldi Invest A/S owned by Jon Stephenson von Tetzchner
- Imperial NIHR Biomedical Research Centre
- Comprehensive Local Research Networks (CLRNs) of which PJMO is an NIHR Senior Investigator [NIHR201385]
- Innovative Medicines Initiative Joint Undertaking [115523]
- European Union [FP7/2007-2013]
- EFPIA companies, in-kind contribution
- INSERM [NCT04262921]
- REACTing (REsearch & ACtion emergING infectious diseases) Consortium
- French Ministry of Health [20-0424]
- Stiftungsfonds zur Forderung der Bekampfung der Tuberkulose und anderer Lungenkrankheiten of the City of Vienna [APCOV22BGM]
- Italian Ministry of Health `Fondi Ricerca corrente-L1P6' [3273191]
- Gender Equity Strategic Fund at University of Queensland, Artificial Intelligence for Pandemics (A14PAN) at University of Queensland
- Australian Research Council Centre of Excellence for Engineered Quantum Systems (EQUS) [CE170100009]
- Prince Charles Hospital Foundation, Australia
- Instituto de Salud Carlos III, Ministerio de Ciencia, Spain
- Brazil, National Council for Scientific and Technological Development Scholarship [303953/2018-7]
- Firland Foundation, Shoreline, Washington, USA
- foundation Bevordering Onderzoek Franciscus
- South Eastern Norway Health Authority
- Research Council of Norway
- Ministry of Health Malaysia
- National Institute for Health Research (NIHR) [CO-CIN-01]
- Medical Research Council (MRC) [MC_PC_19059]
- NIHR Health Protection Research Unit (HPRU) in Emerging and Zoonotic Infections at University of Liverpool in partnership with Public Health England (PHE) [200907]
- NIHR HPRU in Respiratory Infections at Imperial College London with PHE [200927]
- Liverpool Experimental Cancer Medicine Centre [C18616/A25153]
- NIHR Biomedical Research Centre at Imperial College London [ISBRC-1215-20013]
- Wellcome Trust [220757/Z/20/Z] Funding Source: Wellcome Trust
This study analyzed the proportion of laboratory-confirmed COVID-19 hospitalized patients meeting different case definitions in the ISARIC prospective cohort study database. The study found that the performance of case definitions may vary by region, age, and time. Older patients often did not meet case definitions, which could lead to delayed medical care.
Introduction: 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. Methods: 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. Results: A total of 263,218 of the patients (42%) in the ISARIC database were included. Most patients (90.4%) were from Europe arid 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 riot meet the case definition, the CFR increased. Conclusions: 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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