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Abstract

BACKGROUND

Surveillance of severe acute respiratory infections (SARI) using ICD-10 codes from electronic health records (EHR) lacks consensus on optimal case-defining codes.

AIM

We determined codes that maximise sensitivity (Se) and positive predictive value (PPV) for SARI associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), influenza virus and respiratory syncytial virus (RSV) in Denmark, Iceland, Malta, Norway and Spain.

METHODS

We included hospitalisations from week 21/2021 to 39/2023, with ICD-10 diagnostic codes for respiratory disease (three-character codes J00–J99) or COVID-19 (U07.1, U07.2, country-specific codes for Denmark). We assessed Se and PPV of individual codes against laboratory results. Based on Se and PPV rank-sum, we selected the top 10 codes and combined them into 10 sets per pathogen. We identified sets that maximised the clinical utility index (CUI = Se × PPV), categorised as excellent (≥ 0.81), good (0.64–0.80), satisfactory (0.49–0.63) and poor (< 0.49).

RESULTS

We assessed 395,163 hospitalisations for SARI-SARS-CoV-2, 313,418 for SARI-influenza and 192,936 for SARI-RSV, all tested. For SARI-SARS-CoV-2, code U07.1 (B34.2A, B97.2A for Denmark) had excellent utility in Denmark, Malta, Norway, Spain (≥ 0.82), and good utility in Iceland (0.79). For SARI-influenza, J09, J10 and J11 performed excellently in Denmark, Norway, Spain (≥ 0.83), satisfactorily in Malta (0.52), and poorly in Iceland (0.43). For SARI-RSV, J12, J20 and J21 achieved highest CUI but had poor utility (0.17–0.34).

CONCLUSIONS

COVID-19- and influenza-specific three-character ICD-10 codes accurately identified SARI associated with SARS-CoV-2 and influenza virus. For SARI-RSV, four-character codes should be explored. We recommend context-specific assessments in countries adopting EHR-based surveillance.

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2025-07-10
2025-07-12
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Surveillance of severe acute respiratory infections associated with SARS-CoV-2, influenza virus and RSV using ICD-10 codes: a case definition accuracy study across five European countries, 2021 to 2023
<p class="citation"> <span>Citation style for this article:</span> <span class="meta-value authors"> <a href="/search?value1=Miguel+Angel+Sanchez+Ruiz&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Sanchez Ruiz Miguel Angel</a>, <a href="/search?value1=Diogo+FP+Marques&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Marques Diogo FP</a>, <a href="/search?value1=Frederikke+Kristensen+Lomholt&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Lomholt Frederikke Kristensen</a>, <a href="/search?value1=Lasse+Skafte+Vestergaard&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Vestergaard Lasse Skafte</a>, <a href="/search?value1=Susana+Monge&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Monge Susana</a>, <a href="/search?value1=Marcos+Lozano+%C3%81lvarez&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Lozano Álvarez Marcos</a>, <a href="/search?value1=Gudrun+Aspelund&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Aspelund Gudrun</a>, <a href="/search?value1=Marianna+Thordardottir&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Thordardottir Marianna</a>, <a href="/search?value1=Ausra+Dziugyte&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Dziugyte Ausra</a>, <a href="/search?value1=John-Paul+Cauchi&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Cauchi John-Paul</a>, <a href="/search?value1=Tjarda+M+Boere&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Boere Tjarda M</a>, <a href="/search?value1=Irene+K+Veldhuijzen&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Veldhuijzen Irene K</a>, <a href="/search?value1=Elina+Sepp%C3%A4l%C3%A4&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Seppälä Elina</a>, <a href="/search?value1=H%C3%A5kon+B%C3%B8%C3%A5s&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Bøås Håkon</a>, <a href="/search?value1=Trine+Hessevik+Paulsen&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Paulsen Trine Hessevik</a>, <a href="/search?value1=ESURE+SARI+group&option1=author&noRedirect=true" class="nonDisambigAuthorLink">ESURE SARI group</a>, <a href="/search?value1=Ausenda+Machado&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Machado Ausenda</a>, <a href="/search?value1=Ana+Paula+Rodrigues&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Rodrigues Ana Paula</a>, <a href="/search?value1=Mariette+Hooiveld&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Hooiveld Mariette</a>, <a href="/search?value1=Luis+Alves+de+Sousa&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Alves de Sousa Luis</a>, <a href="/search?value1=Ana+Torres&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Torres Ana</a>, <a href="/search?value1=Carlos+Carvalho&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Carvalho Carlos</a>, <a href="/search?value1=Baltazar+Nunes&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Nunes Baltazar</a></span>. Surveillance of severe acute respiratory infections associated with SARS-CoV-2, influenza virus and RSV using ICD-10 codes: a case definition accuracy study across five European countries, 2021 to 2023. <a href="/content/ecdc">Euro Surveill.</a> 2025;30(27):pii=2400748. <a href="https://doi.org/10.2807/1560-7917.ES.2025.30.27.2400748" title="doi link" target="_blank">https://doi.org/10.2807/1560-7917.ES.2025.30.27.2400748</a> <span class="ES_Article_citation"> <span class="generated">Received</span>: 08 Nov 2024;&nbsp;&nbsp; <span class="generated">Accepted</span>: 26 Feb 2025 </span> </p>
/content/10.2807/1560-7917.ES.2025.30.27.2400748
/content/10.2807/1560-7917.ES.2025.30.27.2400748
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