Outcome Phenotypes

[emprestige]

Maximally Specific

Mild RSV

• At least one RSV diagnosis code, or bronchiolitis diagnosis code, in SNOMED CT (codelist), OR,
• In infant population, bronchiolitis diagnosis code (4120002), in SNOMED CT, in first or second position in ECDS (A&E)

Severe RSV

At least one ICD-10 diagnosis code for RSV or bronchiolitis in the first or second position in the HES APC (codelist)

Maximally Sensitive

Mild RSV

Inclusion Criteria

• Meets criteria for ‘maximally specific’ phenotype, OR,
• At least one RSV diagnosis code, or bronchiolitis diagnosis code, in SNOMED CT, OR,
• At least two of the following respiratory symptoms recorded in SNOMED CT within a two-week period (two on the same day is acceptable): rhinitis, cough, fever, breathing abnormalities, viral infections, sepsis, and septicaemia OR,
• (codelist for above)
• In infant population, at least one bronchiolitis (4120002) or viral wheeze (276191000000107) diagnosis code, in SNOMED CT, in any position in ECDS (A&E), OR,
• At least one prescription for antibiotics (amoxicillin, doxycycline, trimethoprim, clarithromycin, phenoxymethylpenicillin, azithromycin, erythromycin, cefalexin, ciprofloxacin, amoxicillin / clavulanic acid (co-amoxiclav), levofloxacin, co-trimoxazole, ceftriaxone or moxifloxacin) or antivirals (oseltamivir or zanamivir) in Pseudo BNF relevant for the treatment of infectious respiratory diseases (codelist), with the presence of at least one diagnosis code from maximally sensitive codelist

Exclusion Criteria

Diagnosis code in SNOMED CT for influenza, pneumonia, human metapneumovirus, rhinovirus, adenovirus, parainfluenza, enterovirus, mycoplasma pneumonia, bronchitis, sinusitis, tonsillitis, laryngitis, pertussis, or coronavirus, including COVID-19, within the one-month period (±) of respiratory symptoms or receipt of a relevant prescription as noted in the inclusion criteria above (codelist)

Severe RSV

Inclusion Criteria

• Meets criteria for ‘maximally specific’ phenotype, OR,
• At least one ICD-10 diagnosis code for RSV or bronchiolitis in any position in the HES APC (codelist), OR,
• ICD-10 diagnosis code for unspecified acute lower respiratory infection (J22) in any position in the HES APC

Exclusion Criteria

ICD-10 diagnosis code in any position in HES APC for influenza, pneumonia, human metapneumovirus, rhinovirus, adenovirus, parainfluenza, enterovirus, mycoplasma pneumonia, bronchitis, sinusitis, tonsillitis, laryngitis, pertussis, or coronavirus, including COVID-19, within the one-month period (±) of respiratory symptoms (codelist)

Maximally Specific

Mild Influenza

At least one SNOMED CT code for influenza (codelist)

Severe Influenza

At least one ICD-10 diagnosis code for influenza in the first or second position in the HES APC (codelist)

Maximally Sensitive

Mild Influenza

Inclusion Criteria

• Meets criteria for ‘maximally specific’ phenotype, OR,
• At least one SNOMED CT code for influenza, suspected influenza, influenza-like-illness, test run for influenza (codelist), OR,
• Record of an acute respiratory illness (codelist) with a measured temperature of ≥ 38 °C (codelist) within the same episode (adapted from definition of influenza-like-illness according to WHO)
• At least one prescription for antivirals (oseltamivir or zanamivir) in Pseudo BNF relevant for the treatment of infectious respiratory diseases (codelist)

Exclusion Criteria

Diagnosis code in SNOMED CT for RSV, pneumonia, human metapneumovirus, rhinovirus, adenovirus, parainfluenza, enterovirus, mycoplasma pneumonia, tonsillitis, pertussis, or coronavirus, including COVID-19, within the one-month period (±) of respiratory symptoms or receipt of a relevant prescription as noted in the inclusion criteria above (codelist)

Severe Influenza

Inclusion Criteria

• Meets criteria for ‘maximally specific’ phenotype, OR,
• At least one ICD-10 diagnosis code for influenza in any position in the HES APC (codelist), OR,
• At least one ICD-10 diagnosis code for acute respiratory illness (codelist) (adapted from definition of influenza-like-illness according to WHO)

Exclusion Criteria

ICD-10 diagnosis code in any position in HES APC for RSV, pneumonia, human metapneumovirus, rhinovirus, adenovirus, parainfluenza, enterovirus, mycoplasma pneumonia, tonsillitis, pertussis, or coronavirus, including COVID-19, within the one-month period (±) of respiratory symptoms (codelist)

Maximally Specific

Mild COVID-19

At least one SNOMED CT code for COVID-19 (codelist)

Severe COVID-19

At least one ICD-10 diagnosis code for COVID-19 in the first or second position in the HES APC (codelist)

Maximally Sensitive

Mild COVID-19

Inclusion Criteria

• Meets criteria for ‘maximally specific’ phenotype, OR,
• At least one SNOMED CT code for COVID-19, coronavirus (without specific strain), suspected COVID-19, tests performed and referrals to support, OR,
• At least two of the following symptoms of COVID-19 recorded in SNOMED CT within a two-week period (two on the same day is acceptable): fever, cough, change to sense of smell or taste, shortness of breath, fatigue, body aches/muscle aches, headache, sore throat, rhinitis, loss of appetite, diarrhoea, nausea and vomiting , OR,
• (codelist for above)
• At least one prescription for antivirals (nirmatrelvir plus ritonavir (Paxlovid) and molnupiravir (Lagevrio)) in Pseudo BNF (codelist)

Exclusion Criteria

Diagnosis code in SNOMED CT for RSV, influenza, pneumonia, human metapneumovirus, rhinovirus, adenovirus, parainfluenza, enterovirus, mycoplasma pneumonia, bronchitis, sinusitis, tonsillitis, pertussis, laryngitis, or specific coronavirus strains which are not COVID-19 within the one-month period (±) of respiratory symptoms or receipt of a relevant prescription as noted in the inclusion criteria above (codelist)

Severe COVID-19

Inclusion Criteria

• Meets criteria for ‘maximally specific’ phenotype, OR,
• At least one ICD-10 diagnosis code for COVID-19 in any position in the HES APC (codelist), OR,
• ICD-10 diagnosis code for Coronavirus as the cause of diseases classified to other chapters (B972) in any position in the HES APC, OR,
• ICD-10 diagnosis code for Coronavirus infection, unspecified site (B342), in any position in the HES APC

Exclusion Criteria

ICD-10 diagnosis code in any position in HES APC for RSV, influenza, pneumonia, human metapneumovirus, rhinovirus, adenovirus, parainfluenza, enterovirus, mycoplasma pneumonia, bronchitis, sinusitis, tonsillitis, pertussis, laryngitis, or specific coronavirus strains which are not COVID-19 within the one-month period (±) of respiratory symptoms (codelist)

Maximally Sensitive

Mild Overall Respiratory Virus

Inclusion Criteria

• Identified from RSV maximally sensitive inclusion criteria, OR,
• Identified from influenza maximally sensitive inclusion criteria, OR,
• Identified from COVID-19 maximally sensitive inclusion criteria, OR,
• Identified from codelist with non-specific conditions associated with respiratory viruses (codelist), OR,
• At least one SNOMED CT code, in any position in ECDS (A&E), for LRTI (50417007) or UTRI (54150009), OR,
• In older adult population, identified as having an exacerbation for COPD (codelist) or Asthma (codelist), in SNOMED CT, OR,
• In older adult population, acute exacerbation of COPD diagnosis code (195951007), in SNOMED CT, in any position in ECDS (A&E)

Exclusion Criteria

Diagnosis code in SNOMED CT for metapneumovirus, rhinovirus, adenovirus, parainfluenza, enterovirus, mycoplasma pneumonia or pertussis within the one-month period (±) of respiratory symptoms (codelist)

Severe Overall Respiratory Virus

Inclusion Criteria

• Identified from RSV maximally sensitive inclusion criteria, OR,
• Identified from influenza maximally sensitive inclusion criteria, OR,
• Identified from COVID-19 maximally sensitive inclusion criteria, OR,
• Identified from codelist with non-specific conditions associated with respiratory viruses (codelist), in ICD-10, in any position in HES APC, OR,
• In older adult population, identified as having an exacerbation for COPD (codelist) or Asthma (codelist), in ICD-10, in any position in HES APC

Exclusion Criteria

ICD-10 diagnosis code in any position in HES APC for metapneumovirus, rhinovirus, adenovirus, parainfluenza, enterovirus, mycoplasma pneumonia or pertussis within the one-month period (±) of respiratory symptoms (codelist)

[emprestige]

edited to add clarity of diagnosis positions for emergency admissions and exclusion criteria

[emprestige]

edited to change definition of influenza-like-illness for Maximally Sensitive Mild Influenza definition - presence of code from cough codelist no longer required

[emprestige]

edited to add detail to maximally sensitive phenotypes for RSV, flu, and COVID-19