ArticlePloS one2020
Evaluating the diagnostic accuracy of the WHO Severe Acute Respiratory Infection (SARI) criteria in Middle Eastern children under two years over three respiratory seasons.
Article in PloS one, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers, 1 of them a synthesis that pooled it.
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Who cites it
11 citing papers in PubMed, 1 synthesis or guideline pooled it, 12 citations in OpenAlex.
- Diagnostic Accuracy of Severe Acute Respiratory Infection Definitions in Hospitalized Children: A Systematic Review and Meta-Analysis.JAMA network open · 2025Pooled it
- Clinical presentation and hospitalisation risk of RSV in primary care among children younger than 5 years in Italy in four seasons between 2019 and 2023: a multicentre prospective cohort study.The Lancet regional health. Europe · 2026Article
- Enhancing respiratory virus surveillance among hospitalised children: a machine learning-based predictive model.BMJ paediatrics open · 2026Article
- Research on age-stratified prevention and control strategies for pediatric RSV infection based on disease burden disparities.BMC infectious diseases · 2026Article
- Epidemiology of viral and atypical bacterial respiratory infections among children hospitalised at a Kenyan tertiary referral centre: a cross sectional multiplex PCR study.Frontiers in pediatrics · 2026Article
- RSV-infected children with mixed infections: clinical features and early predictive indicators of codetection withFrontiers in pediatrics · 2026Article
- Surveillance of respiratory viruses in severe acute respiratory infections in Southern Brazil, 2023-2024.BMC infectious diseases · 2025Article
- Epidemiological and clinical characteristics of bacterial co-detection in respiratory syncytial virus-positive children in Wenzhou, China, 2021 to 2023.BMC infectious diseases · 2025Observational
- Performance of the World Health Organization (WHO) severe acute respiratory infection (SARI) case definitions in hospitalized children and youth: cross-sectional study.Lancet regional health. Americas · 2025Article
- Correlation Between Inflammatory Markers and Pathogenic Bacteria in Children's Winter Respiratory Infections in Xinjiang.International journal of general medicine · 2025Article
- Assessing the epidemiology and seasonality of influenza among children under two hospitalized in Amman, Jordan, 2010-2013.Influenza and other respiratory viruses · 2021Article
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Authors and funding
9 authors at 6 institutions in 2 countries.
Funding
Abstract
objectiveThe 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. MATERIALS AND
methodsThe 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.
resultsOf 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.
conclusionsThe 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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