{
  "abstract": "Background Viral respiratory tract infections (vRTIs) are a leading cause of paediatric hospitalisation and healthcare utilisation. Existing syndromic surveillance tools, including the WHO Severe Acute Respiratory Infection definition, demonstrate limited diagnostic accuracy in children whose symptom profiles vary widely. This study aimed to develop a machine learning (ML) model to predict microbiologically confirmed vRTIs in hospitalised children and to evaluate performance across age groups and viral pathogens.Methods We conducted a retrospective cross-sectional study of 2050 paediatric patients (<18 years) admitted with acute respiratory infections to two tertiary paediatric hospitals in Canada. Predictors included age, sex, hospital transfer status, chronic comorbidity status and 22 presenting symptoms. The primary outcome was microbiologically confirmed vRTI, determined by multiplex PCR or rapid antigen testing. Six ML algorithms were trained and the best-performing model, identified by area under the receiver operating characteristic curve (auROC), was tested on age subgroups, viral pathogens and sites.Results Among 2050 patients (median (IQR) age 2.4 (0.8–5.2) years), 1831 (89.3%) tested positive, most commonly for respiratory syncytial virus (RSV) (38.7%) and enterovirus/rhinovirus (32.8%). Logistic regression with L2 regularisation demonstrated the best performance (auROC, 0.754; 95% CI 0.697 to 0.808; sensitivity, 69.2%; specificity, 69.9%), with greatest performance among children <1 year (auROC, 0.763) and RSV cases (auROC, 0.727).Conclusions An ML-based logistic regression model using admission data accurately predicted paediatric vRTIs, outperforming traditional syndromic surveillance definitions, especially among infants <1 year. By integrating ML models into hospital electronic medical records, healthcare systems can achieve enhanced respiratory virus surveillance, faster outbreak detection, greater diagnostic efficiency and improved pandemic preparedness.",
  "authors": [
    {
      "affiliations": [
        "Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada",
        "Child Health Evaluative Services, SickKids Research Institute, Toronto, Ontario, Canada"
      ],
      "name": "Tuana Kant"
    },
    {
      "affiliations": [
        "Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada"
      ],
      "name": "Rohini R Datta"
    },
    {
      "affiliations": [
        "Child Health Evaluative Services, SickKids Research Institute, Toronto, Ontario, Canada",
        "Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada"
      ],
      "name": "Daniel S Farrar"
    },
    {
      "affiliations": [
        "Child Health Evaluative Services, SickKids Research Institute, Toronto, Ontario, Canada",
        "Divison of Paediatric Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada",
        "Interdepartmental Division of Pediatric Critical Care Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada"
      ],
      "name": "Haifa Mtaweh"
    },
    {
      "affiliations": [
        "Child Health Evaluative Services, SickKids Research Institute, Toronto, Ontario, Canada"
      ],
      "name": "Caitlyn L Kaziev"
    },
    {
      "affiliations": [
        "Child Health Evaluative Services, SickKids Research Institute, Toronto, Ontario, Canada",
        "Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada"
      ],
      "name": "Yujie Chen"
    },
    {
      "affiliations": [
        "Child Health Evaluative Services, SickKids Research Institute, Toronto, Ontario, Canada",
        "Divison of Paediatric Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada",
        "Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada",
        "Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada"
      ],
      "name": "Sanjay Mahant"
    },
    {
      "affiliations": [
        "Division of Pediatric Hospital Medicine, BC Children’s Hospital, Vancouver, British Columbia, Canada",
        "BC Children’s Hospital Research Institute, Vancouver, British Columbia, Canada",
        "Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada"
      ],
      "name": "Claire Seaton"
    },
    {
      "affiliations": [
        "Clinical Research Unit, Children’s Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada"
      ],
      "name": "Mei Han"
    },
    {
      "affiliations": [
        "Child Health Evaluative Services, SickKids Research Institute, Toronto, Ontario, Canada",
        "Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada",
        "Division of Pediatric Emergency Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada"
      ],
      "name": "Gabrielle Freire"
    },
    {
      "affiliations": [
        "Division of Microbiology, The Hospital for Sick Children, Toronto, Ontario, Canada",
        "Department of Laboratory Medicine & Pathobiology, University of Toronto, Toronto, Ontario, Canada"
      ],
      "name": "Aaron Campigotto"
    },
    {
      "affiliations": [
        "Child Health Evaluative Services, SickKids Research Institute, Toronto, Ontario, Canada",
        "Centre for Innovation and Excellence in Child and Family-Centred Care, The Hospital for Sick Children, Toronto, Ontario, Canada"
      ],
      "name": "Francine Buchanan"
    },
    {
      "affiliations": [
        "Child Health Evaluative Services, SickKids Research Institute, Toronto, Ontario, Canada",
        "Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada",
        "Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada",
        "Division of Pediatric Infectious Diseases, Hospital for Sick Children, Toronto, Ontario, Canada",
        "Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada"
      ],
      "name": "Shaun K Morris"
    },
    {
      "affiliations": [
        "Child Health Evaluative Services, SickKids Research Institute, Toronto, Ontario, Canada",
        "Divison of Paediatric Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada",
        "Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada",
        "Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada"
      ],
      "name": "Peter J Gill"
    },
    {
      "affiliations": [],
      "name": "for the READAPT-Kids Study"
    }
  ],
  "title": "Enhancing respiratory virus surveillance among hospitalised children: a machine learning-based predictive model",
  "uid": "e24da425-e300-5da9-ac70-23875264e04b"
}