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Are we missing respiratory viral infections in infants and children? Comparison of a hospital-based quality management system with standard of care.
Clin Microbiol Infect 2019; 25(3):380.e9-380.e16CM

Abstract

OBJECTIVES

Hospital-based surveillance of influenza and acute respiratory infections relies on International Classification of Diseases (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 compared the diagnostic accuracy of standard surveillance methods with a prospective quality management (QM) programme at a Berlin children's hospital with the Robert Koch Institute.

METHODS

Independent from routine care, all patients fulfilling pre-defined ILI-criteria (QM-ILI) participated in the QM programme. A separate QM team conducted standardized clinical assessments and collected nasopharyngeal specimens for blinded real-time quantitative PCR for influenza A/B viruses, respiratory syncytial virus, adenovirus, rhinovirus and human metapneumovirus.

RESULTS

Among 6073 individuals with ILI qualifying for the QM programme, 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. Of baseline ICD codes, 53.2% (2811/5282) 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 had the highest sensitivity for influenza infections (36%, 95% CI 31.4-40.8 for influenza A and 48%, 95% CI 40.5-54.7 for influenza B).

CONCLUSIONS

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 should be based on the WHO ILI case definition combined with targeted testing.

Authors+Show Affiliations

Department of Paediatrics, Charité University Berlin, Germany; Vienna Vaccine Safety Initiative, Berlin, Germany.Department of Mathematics and Computer Sciences, Freie Universität Berlin, Germany.Vienna Vaccine Safety Initiative, Berlin, Germany.Department of Paediatrics, Charité University Berlin, Germany; Vienna Vaccine Safety Initiative, Berlin, Germany; National Reference Centre for Influenza, Robert Koch Institute, Berlin, Germany.European Centre for Disease Prevention and Control, Stockholm, Sweden.European Centre for Disease Prevention and Control, Stockholm, Sweden.National Reference Centre for Influenza, Robert Koch Institute, Berlin, Germany.National Reference Centre for Influenza, Robert Koch Institute, Berlin, Germany.National Reference Centre for Influenza, Robert Koch Institute, Berlin, Germany.Department of Paediatrics, Charité University Berlin, Germany; Vienna Vaccine Safety Initiative, Berlin, Germany; University of Nottingham School of Medicine, Nottingham, UK. Electronic address: Barbara.Rath@nottingham.ac.uk.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

29906596

Citation

Alchikh, M, et al. "Are We Missing Respiratory Viral Infections in Infants and Children? Comparison of a Hospital-based Quality Management System With Standard of Care." Clinical Microbiology and Infection : the Official Publication of the European Society of Clinical Microbiology and Infectious Diseases, vol. 25, no. 3, 2019, pp. 380.e9-380.e16.
Alchikh M, Conrad T, Hoppe C, et al. Are we missing respiratory viral infections in infants and children? Comparison of a hospital-based quality management system with standard of care. Clin Microbiol Infect. 2019;25(3):380.e9-380.e16.
Alchikh, M., Conrad, T., Hoppe, C., Ma, X., Broberg, E., Penttinen, P., ... Rath, B. (2019). Are we missing respiratory viral infections in infants and children? Comparison of a hospital-based quality management system with standard of care. Clinical Microbiology and Infection : the Official Publication of the European Society of Clinical Microbiology and Infectious Diseases, 25(3), pp. 380.e9-380.e16. doi:10.1016/j.cmi.2018.05.023.
Alchikh M, et al. Are We Missing Respiratory Viral Infections in Infants and Children? Comparison of a Hospital-based Quality Management System With Standard of Care. Clin Microbiol Infect. 2019;25(3):380.e9-380.e16. PubMed PMID: 29906596.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Are we missing respiratory viral infections in infants and children? Comparison of a hospital-based quality management system with standard of care. AU - Alchikh,M, AU - Conrad,T, AU - Hoppe,C, AU - Ma,X, AU - Broberg,E, AU - Penttinen,P, AU - Reiche,J, AU - Biere,B, AU - Schweiger,B, AU - Rath,B, Y1 - 2018/06/12/ PY - 2018/04/29/received PY - 2018/05/28/revised PY - 2018/05/30/accepted PY - 2018/6/16/pubmed PY - 2018/6/16/medline PY - 2018/6/16/entrez KW - Case definitions KW - Children KW - Diagnostics KW - Influenza KW - Influenza-like illness KW - International classification of disease coding KW - Quality management KW - Respiratory viruses SP - 380.e9 EP - 380.e16 JF - Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases JO - Clin. Microbiol. Infect. VL - 25 IS - 3 N2 - OBJECTIVES: Hospital-based surveillance of influenza and acute respiratory infections relies on International Classification of Diseases (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 compared the diagnostic accuracy of standard surveillance methods with a prospective quality management (QM) programme at a Berlin children's hospital with the Robert Koch Institute. METHODS: Independent from routine care, all patients fulfilling pre-defined ILI-criteria (QM-ILI) participated in the QM programme. A separate QM team conducted standardized clinical assessments and collected nasopharyngeal specimens for blinded real-time quantitative PCR for influenza A/B viruses, respiratory syncytial virus, adenovirus, rhinovirus and human metapneumovirus. RESULTS: Among 6073 individuals with ILI qualifying for the QM programme, 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. Of baseline ICD codes, 53.2% (2811/5282) 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 had the highest sensitivity for influenza infections (36%, 95% CI 31.4-40.8 for influenza A and 48%, 95% CI 40.5-54.7 for influenza B). CONCLUSIONS: 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 should be based on the WHO ILI case definition combined with targeted testing. SN - 1469-0691 UR - https://www.unboundmedicine.com/medline/citation/29906596/Are_we_missing_respiratory_viral_infections_in_infants_and_children_Comparison_of_a_hospital_based_quality_management_system_with_standard_of_care_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1198-743X(18)30458-0 DB - PRIME DP - Unbound Medicine ER -