Evaluating the diagnostic accuracy of the WHO Severe Acute Respiratory Infection (SARI) criteria in Middle Eastern children under two years over three respiratory seasons

The World Health Organization created the Severe Acute Respiratory Infection (SARI) criteria in 2011 to monitor influenza (flu)-related hospitalization. Many studies have since used the SARI case definition as inclusion criteria for surveillance studies. We sought to determine the sensitivity, speci...

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Veröffentlicht in:PloS one Jg. 15; H. 4; S. e0232188
Hauptverfasser: Klink, Thomas, Rankin, Danielle A., Piya, Bhinnata, Spieker, Andrew J., Faouri, Samir, Shehabi, Asem, Williams, John V., Khuri-Bulos, Najwa, Halasa, Natasha B.
Format: Journal Article
Sprache:Englisch
Veröffentlicht: United States Public Library of Science 30.04.2020
Public Library of Science (PLoS)
Schlagworte:
Accuracy
Age
Biology and Life Sciences
Children
Cough
Cough - virology
Criteria
Diagnostic systems
Female
Fever
Fever - virology
Health surveillance
Hospitalization
Hospitals
Humans
Illnesses
Infant
Infections
Influenza
Influenza, Human - diagnosis
Influenza, Human - virology
Jordan
Male
Medical diagnosis
Medicine and Health Sciences
Pediatrics
People and Places
Pharynx
Pneumonia
Polymerase chain reaction
Prospective Studies
Questionnaires
Real-Time Polymerase Chain Reaction
Respiratory diseases
Respiratory syncytial virus
Respiratory Syncytial Virus Infections - diagnosis
Respiratory Syncytial Virus Infections - virology
Respiratory Syncytial Viruses - pathogenicity
Respiratory tract infection
Seasons
Sensitivity
Sensitivity and Specificity
Sepsis
Signs and symptoms
Studies
Supervision
Surveillance
Viruses
Whooping cough
World Health Organization
Jordan
Pittsburgh Pennsylvania
United States > US
Tennessee
Nashville Tennessee
ISSN:1932-6203, 1932-6203
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Zusammenfassung:The World Health Organization created the Severe Acute Respiratory Infection (SARI) criteria in 2011 to monitor influenza (flu)-related hospitalization. Many studies have since used the SARI case definition as inclusion criteria for surveillance studies. We sought to determine the sensitivity, specificity, positive predictive value, and negative predictive value of the SARI criteria for detecting ten different respiratory viruses in a Middle Eastern pediatric cohort. The data for this study comes from a prospective acute respiratory surveillance study of hospitalized children <2 years in Amman, Jordan from March 16, 2010 to March 31, 2013. Participants were recruited if they had a fever and/or respiratory symptoms. Nasal and throat swabs were obtained and tested by real-time RT-PCR for eleven viruses. Subjects meeting SARI criteria were determined post-hoc. Sensitivity, specificity, positive predictive value, and negative predictive value of the SARI case definition for detecting ten different viruses were calculated and results were stratified by age. Of the 3,175 patients enrolled, 3,164 were eligible for this study, with a median age of 3.5 months, 60.4% male, and 82% virus-positive (44% RSV and 3.8% flu). The sensitivity and specificity of the SARI criteria for detecting virus-positive patients were 44% and 77.9%, respectively. Sensitivity of SARI criteria for any virus was lowest in children <3 months at 22.4%. Removing fever as a criterion improved the sensitivity by 65.3% for detecting RSV in children <3 months; whereas when cough was removed, the sensitivity improved by 45.5% for detecting flu in same age group. The SARI criteria have poor sensitivity for detecting RSV, flu, and other respiratory viruses-particularly in children <3 months. Researchers and policy makers should use caution if using the criteria to estimate burden of disease in children.
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Competing Interests: N.H. received grants from Sanofi and Quidel and consulting fees for Moderna, and Karius outside the submitted work. J.V.W. reports personal fees from Quidel, personal fees from GlaxoSmithKline outside the submitted work. For the remaining authors, none were declared. This work was supported by the UBS Optimus Foundation; National Institutes of Health: R01AI085062, and the CTSA award UL1TR000445 from the National Center for Advancing Translational Sciences. Its contents are solely the responsibility of the authors and do not necessarily represent official views of the National Center for Advancing Translational Sciences or the National Institutes of Health.
These authors are joint senior authors on this work.
ISSN:1932-6203
1932-6203
DOI:10.1371/journal.pone.0232188