Surveillance of severe acute respiratory infections using ICD-10 diagnosis codes and national electronic health records, Denmark, 2022 to 2024

Abstract

BACKGROUNDThe COVID-19 pandemic underscored the need and value of a standardised and timely surveillance system for severe acute respiratory infections (SARI) to inform epidemic preparedness and response.AIMWe aimed to develop an automated SARI surveillance system using electronic health records retrieved from pre-existing national health registers in Denmark.METHODSWe used the Danish Civil Register, the Danish National Patient Register and the Danish Microbiology Database to set up the system. First, we determined a SARI case definition for surveillance, choosing among six different potentially usable combinations of ICD-10 diagnosis codes by exploring how each combination captured patient characteristics (age, hospital admission length, mortality, laboratory tests and seasonality). Second, using this case definition, we evaluated the surveillance system's timeliness and completeness by comparing weekly data reported with a delay of 1, 8, 15, 22 and 29 days, respectively, against a complete set of data extracted after 120 days.RESULTSThe selected case definition combined ICD-10 codes for influenza (J09-J11), acute lower viral and bacterial respiratory tract infections and bronchiolitis (J12-J22) and COVID-19 (B342A and B972A). With regards to timeliness and completeness of this definition, weekly data reported with a delay of 8 days was 89-93% complete and showed very similar patterns in weekly changes in SARI cases as data reported after 120 days.CONCLUSIONOur SARI surveillance system detected fluctuations in weekly SARI cases in a consistent and timely manner. We recommend countries to explore using electronic health registers as a resource-efficient alternative to standard SARI sentinel surveillance.

Keywords: automated surveillance; case definition; electronic health records (EHR); epidemiology; integrated surveillance; register-based; severe acute respiratory infections (SARI).

Figure 1

Electronic health records retrieved from national registers to create the national electronic health record-based severe acute respiratory infection surveillance database, Denmark, 2022–2023 (n = 3 registers)

Figure 2

Weekly number of severe acute respiratory infection cases and admissions with severe acute respiratory syndrome coronavirus 2, influenza virus and respiratory syncytial virus separately and combined by case definition, Denmark, week 1 2022–week 52 2023 (n = 6 case definitions)

Figure 3

Total number of admissions identified by week when data was extracted with a delay of 1 day, 8 days, 15 days, 22 days and 29 days, respectively, compared with complete dataset, Denmark, week 40 2023–week 8 2024 (n = 6 timepoints)