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However, how they identify COVID\u201019\u2010hospitalised patients is not fully understood. We analysed the proportion of hospitalised patients with laboratory\u2010confirmed COVID\u201019, in the ISARIC prospective cohort study database, meeting widely used case definitions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Patients were assessed using the Centers for Disease Control (CDC), European Centre for Disease Prevention and Control (ECDC), World Health Organization (WHO) and UK Health Security Agency (UKHSA) case definitions by age, region and time. Case fatality ratios (CFRs) and symptoms of those who did and who did not meet the case definitions were evaluated. Patients with incomplete data and non\u2010laboratory\u2010confirmed test result were excluded.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 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\u2009years; geographical and time variations were also observed. Estimated CFRs were similar for the patients who met the case definitions. However, when more patients did not meet the case definition, the CFR increased.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>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, risking delayed medical care. 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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/irv.13039","type":"journal-article","created":{"date-parts":[[2022,9,5]],"date-time":"2022-09-05T06:37:01Z","timestamp":1662359821000},"page":"1040-1050","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Symptom\u2010based case definitions for COVID\u201019: Time and geographical variations for detection at hospital admission among 260,000 patients"],"prefix":"10.1111","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0806-3183","authenticated-orcid":false,"given":"Joaquin","family":"Baruch","sequence":"first","affiliation":[{"name":"ISARIC, Pandemic Sciences Institute University of Oxford  Oxford UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3948-0756","authenticated-orcid":false,"given":"Amanda","family":"Rojek","sequence":"additional","affiliation":[{"name":"ISARIC, Pandemic Sciences Institute University of Oxford  Oxford UK"},{"name":"Centre for Integrated Critical Care University of Melbourne  Melbourne Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3981-3418","authenticated-orcid":false,"given":"Christiana","family":"Kartsonaki","sequence":"additional","affiliation":[{"name":"MRC Population Health Unit, Clinical Trials Service Unit and Epidemiological Studies Unit University of Oxford  Oxford UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1801-0667","authenticated-orcid":false,"given":"Bharath K. T.","family":"Vijayaraghavan","sequence":"additional","affiliation":[{"name":"Apollo Hospitals  Chennai India"},{"name":"The George Institute for Global Health  New Delhi India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bronner P.","family":"Gon\u00e7alves","sequence":"additional","affiliation":[{"name":"ISARIC, Pandemic Sciences Institute University of Oxford  Oxford UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1726-8989","authenticated-orcid":false,"given":"Mark G.","family":"Pritchard","sequence":"additional","affiliation":[{"name":"ISARIC, Pandemic Sciences Institute University of Oxford  Oxford UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4168-1960","authenticated-orcid":false,"given":"Laura","family":"Merson","sequence":"additional","affiliation":[{"name":"ISARIC, Pandemic Sciences Institute University of Oxford  Oxford UK"},{"name":"Infectious Diseases Data Observatory, Centre for Tropical Medicine and Global Health University of Oxford  Oxford UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4035-4562","authenticated-orcid":false,"given":"Jake","family":"Dunning","sequence":"additional","affiliation":[{"name":"ISARIC, Pandemic Sciences Institute University of Oxford  Oxford UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matthew","family":"Hall","sequence":"additional","affiliation":[{"name":"Big Data Institute University of Oxford  Oxford UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Louise","family":"Sigfrid","sequence":"additional","affiliation":[{"name":"ISARIC, Pandemic Sciences Institute University of Oxford  Oxford UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8968-0708","authenticated-orcid":false,"given":"Barbara W.","family":"Citarella","sequence":"additional","affiliation":[{"name":"ISARIC, Pandemic Sciences Institute University of Oxford  Oxford UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9476-839X","authenticated-orcid":false,"given":"Srinivas","family":"Murthy","sequence":"additional","affiliation":[{"name":"Faculty of Medicine University of British Columbia  Vancouver Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Trokon O.","family":"Yeabah","sequence":"additional","affiliation":[{"name":"Infectious Diseases Data Observatory, Centre for Tropical Medicine and Global Health University of Oxford  Oxford UK"},{"name":"National Public Health Institute of Liberia  Paynesville Liberia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1426-3680","authenticated-orcid":false,"given":"Piero","family":"Olliaro","sequence":"additional","affiliation":[{"name":"ISARIC, Pandemic Sciences Institute University of Oxford  Oxford UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"name":"ISARIC Clinical Characterisation Group","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2022,9,5]]},"reference":[{"key":"e_1_2_10_2_1","unstructured":"CDC.Coronavirus Disease 2019 (COVID\u201019) 2020 Interim Case Definition.2021. Available at:https:\/\/ndc.services.cdc.gov\/case-definitions\/coronavirus-disease-2019-2021\/"},{"key":"e_1_2_10_3_1","unstructured":"ECDC.Case definition for coronavirus disease 2019 (COVID\u201019) as of 3 December 2020.2020. Available at:https:\/\/www.ecdc.europa.eu\/en\/covid-19\/surveillance\/case-definition"},{"key":"e_1_2_10_4_1","unstructured":"UKHSA.COVID\u201019: investigation and initial clinical management of possible cases.2020. Available at:https:\/\/www.gov.uk\/government\/publications\/wuhan-novel-coronavirus-initial-investigation-of-possible-cases\/investigation-and-initial-clinical-management-of-possible-cases-of-wuhan-novel-coronavirus-wn-cov-infection"},{"key":"e_1_2_10_5_1","unstructured":"WHO.World Health Organization. WHO COVID\u201019: case definition. Updated in public health surveillance for COVID\u201019.2020. Available at:https:\/\/www.who.int\/publications\/i\/item\/WHO-2019-nCoV-Surveillance_Case_Definition-2020.2"},{"key":"e_1_2_10_6_1","unstructured":"WHO.Clinical management living guidance COVID\u201019.2021: 16\u201344. Available at:https:\/\/apps.who.int\/iris\/handle\/10665\/338882"},{"key":"e_1_2_10_7_1","unstructured":"World Health Organization.A clinical case definition of post COVID\u201019 condition by a Delphi consensus. Who2020."},{"key":"e_1_2_10_8_1","first-page":"19","article-title":"The value of open\u2010source clinical science in pandemic response: lessons from ISARIC","author":"ISARIC CCG","year":"2021","journal-title":"Lancet"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1093\/ije\/dyu029"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.m1985"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1007\/s15010\u2010021\u201001599\u20105"},{"key":"e_1_2_10_12_1","first-page":"1","article-title":"Ten months of temporal variation in the clinical journey of hospitalised patients with COVID\u201019: an observational cohort","volume":"10","author":"Hall M","year":"2021","journal-title":"Elife"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.3201\/eid2801.211082"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2468\u20102667(20)30089\u2010X"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2589\u20107500(21)00272\u20107"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1473\u20103099(21)00048\u20107"}],"container-title":["Influenza and Other Respiratory Viruses"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/irv.13039","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/irv.13039","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/irv.13039","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,7,31]],"date-time":"2024-07-31T11:59:56Z","timestamp":1722427196000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/irv.13039"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,9,5]]},"references-count":15,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2022,11]]}},"alternative-id":["10.1111\/irv.13039"],"URL":"https:\/\/doi.org\/10.1111\/irv.13039","archive":["Portico"],"relation":{"has-review":[{"id-type":"doi","id":"10.1111\/IRV.13039\/v1\/decision1","asserted-by":"object"},{"id-type":"doi","id":"10.1111\/IRV.13039\/v2\/decision1","asserted-by":"object"},{"id-type":"doi","id":"10.1111\/IRV.13039\/v2\/response1","asserted-by":"object"}]},"ISSN":["1750-2640","1750-2659"],"issn-type":[{"value":"1750-2640","type":"print"},{"value":"1750-2659","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,9,5]]},"assertion":[{"value":"2022-06-29","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-08-07","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-09-05","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}