loading page

Symptom-based case definitions for COVID-19: time and geographical variations for detection at hospital admission among 260,000 patients
  • +11
  • ISARIC Clinical Characterisation Group,
  • Joaquin Baruch,
  • Amanda Rojek,
  • Christiana Kartsonaki,
  • Bharath Vijayaraghavan,
  • Bronner Gonçalves,
  • Mark Pritchard,
  • Laura Merson,
  • Jake Dunning,
  • Louise Sigfrid,
  • Barbara Citarella,
  • Srinivas Murthy,
  • Trokon Yeabah,
  • Piero Olliaro
ISARIC Clinical Characterisation Group
NA

Corresponding Author:ncov@isaric.org

Author Profile
Joaquin Baruch
University of Oxford
Author Profile
Amanda Rojek
University of Oxford
Author Profile
Christiana Kartsonaki
University of Oxford
Author Profile
Bharath Vijayaraghavan
Apollo Hospitals Enterprise Ltd
Author Profile
Bronner Gonçalves
University of Oxford
Author Profile
Mark Pritchard
University of Oxford
Author Profile
Laura Merson
University of Oxford
Author Profile
Jake Dunning
University of Oxford
Author Profile
Louise Sigfrid
University of Oxford
Author Profile
Barbara Citarella
University of Oxford
Author Profile
Srinivas Murthy
University of British Columbia
Author Profile
Trokon Yeabah
University of Oxford
Author Profile
Piero Olliaro
University of Oxford
Author Profile

Abstract

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 CDC, ECDC, WHO, and UKHSA case definitions by age, region, and time. Case fatality ratios (CFR) 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: 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 that met the case definitions. However, when more patients did not 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. 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.
29 Jun 2022Submitted to Influenza and other respiratory viruses
30 Jun 2022Assigned to Editor
30 Jun 2022Submission Checks Completed
06 Jul 2022Editorial Decision: Revise Minor
20 Jul 20221st Revision Received
23 Jul 2022Submission Checks Completed
23 Jul 2022Assigned to Editor
07 Aug 2022Editorial Decision: Accept