A Systematic Review of the Markers of Severity in Acute Respiratory Infections to Inform Primary Care Surveillance

A Systematic Review of the Markers of Severity in Acute Respiratory Infections to Inform Primary Care Surveillance | Authorea try { document.documentElement.classList.add('js'); } catch (e) { } var _gaq = _gaq || []; _gaq.push(['_setAccount', 'G-8VDV14Y67G']); _gaq.push(['_trackPageview']); (function() { var ga = document.createElement('script'); ga.type = 'text/javascript'; ga.async = true; ga.src = ('https:' == document.location.protocol ? 'https://ssl' : 'http://www') + '.google-analytics.com/ga.js'; var s = document.getElementsByTagName('script')[0]; s.parentNode.insertBefore(ga, s); })(); Skip to main content Preprints Collections Wiley Open Research IET Open Research Ecological Society of Japan All Collections About About Authorea FAQs Contact Us Quick Search anywhere Search for preprint articles, keywords, etc. Search Search ADVANCED SEARCH SCROLL Influenza and other respiratory viruses This is a preprint and has not been peer reviewed. Data may be preliminary. 18 July 2025 V1 Latest version Share on A Systematic Review of the Markers of Severity in Acute Respiratory Infections to Inform Primary Care Surveillance Authors : William H. Elson 0000-0002-8630-1378 [email protected] , Anna Forbes , Gavin Jamie 0000-0001-9147-7784 , Rashmi Wimalaratna , Roger Morbey 0000-0001-8543-477X , Richard Hobbs , Simon de Lusignan 0000-0002-8553-2641 , and Jamie Lopez Bernal Authors Info & Affiliations https://doi.org/10.22541/au.175284557.70911399/v1 Published Influenza and Other Respiratory Viruses Version of record Peer review timeline 312 views 184 downloads Contents Abstract Supplementary Material Information & Authors Metrics & Citations View Options References Figures Tables Media Share Abstract Background: Primary care computerised medical records (CMR) are used to report the incidence of acute respiratory infections (ARI) for public health surveillance. These systems could increase their utility by also reporting population-level severity of ARI, however, this is rarely done. Objectives: To identify candidate markers of ARI severity suitable for use in primary care CMR-based surveillance. Methods: We undertook a systematic review of bibliographic databases and grey literature. Eligible studies reported characteristics for > 500 patients with ARI, severe ARI, influenza-like illness, or suspected COVID-19. Studies had to report at least one potential marker of severity. A panel of clinical primary care informaticians reviewed candidate severity markers and assessed each for severity, specificity, relevance to primary care, and whether it was likely to be recorded in a CMR. Results: We included 126 studies from 84 countries. Seventy-seven candidate severity markers were identified across 11 groups. These included 4 outcome groups (complications, hospital events and death) and 7 predictor groups (symptoms, signs, scores, treatments, absenteeism, and health-seeking behaviour). Thirty markers were considered suitable for primary care CMR-based ARI surveillance, 7 outcomes (such as hospital admission, attendance, and death) and 23 predictors (such as shortness of breath, oxygen levels, work absence, and antibiotics). Predictors were generally considered more timely as they are likely recorded during the consultation. Conclusions: This review provides a list of severity markers that could support development of population-level severity indicators for ARI surveillance in primary care. This could improve real-time situational awareness during respiratory outbreaks. Supplementary Material File (manuscript.docx) Download 2.66 MB Information & Authors Information Version history V1 Version 1 18 July 2025 Peer review timeline Published Influenza and Other Respiratory Viruses Version of Record 24 Oct 2025 Published Copyright This work is licensed under a Non Exclusive No Reuse License. Collection Influenza and other respiratory viruses Keywords electronic health records human influenza primary health care public health surveillance respiratory syncytial viruses respiratory tract infections sars-cov-2 systematic review Authors Affiliations William H. Elson 0000-0002-8630-1378 [email protected] University of Oxford Nuffield Department of Primary Care Health Sciences View all articles by this author Anna Forbes University of Oxford Nuffield Department of Primary Care Health Sciences View all articles by this author Gavin Jamie 0000-0001-9147-7784 University of Oxford Nuffield Department of Primary Care Health Sciences View all articles by this author Rashmi Wimalaratna University of Oxford Nuffield Department of Primary Care Health Sciences View all articles by this author Roger Morbey 0000-0001-8543-477X University of Bristol Medical School View all articles by this author Richard Hobbs University of Oxford Nuffield Department of Primary Care Health Sciences View all articles by this author Simon de Lusignan 0000-0002-8553-2641 University of Oxford Nuffield Department of Primary Care Health Sciences View all articles by this author Jamie Lopez Bernal UK Health Security Agency - Colindale View all articles by this author Metrics & Citations Metrics Article Usage 312 views 184 downloads .FvxKWukQNSOunydq8rnd { width: 100px; } Citations Download citation William H. Elson, Anna Forbes, Gavin Jamie, et al. A Systematic Review of the Markers of Severity in Acute Respiratory Infections to Inform Primary Care Surveillance. Authorea . 18 July 2025. DOI: https://doi.org/10.22541/au.175284557.70911399/v1 If you have the appropriate software installed, you can download article citation data to the citation manager of your choice. Simply select your manager software from the list below and click Download. For more information or tips please see 'Downloading to a citation manager' in the Help menu . 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