Distinguishing Admissions Specifically for COVID-19 from Incidental SARS-CoV-2 Admissions: A National EHR Research Consortium Study
Jeffrey Gordon Klann, Zachary H. Strasser, Meghan R. Hutch, Chris J. Kennedy, Jayson S. Marwaha, Michele M. Morris, Malarkodi Jebathilagam Samayamuthu, Ashley Pfaff, Hossein Estiri, Andrew Michael South, Griffin M. Weber, William Yuan, Paul Avillach, Kavishwar B. Wagholikar, Yuan Luo, Gilbert S. Omenn, Shyam Visweswaran, John Haynes Holmes, Zongqi Xia, Gabriel A. Brat · medRxiv · 2022
Admissions are generally classified as COVID-19 hospitalizations if the patient has a positive SARS-CoV-2 polymerase chain reaction (PCR) test. However, because 35% of SARS-CoV-2 infections are asymptomatic, patients admitted for unrelated indications with an incidentally positive test could be misclassified as a COVID-19 hospitalization. EHR-based studies have been unable to distinguish between a hospitalization specifically for COVID-19 versus an incidental SARS-CoV-2 hospitalization. From a retrospective EHR-based cohort in four US healthcare systems, a random sample of 1,123 SARS-CoV-2 PCR-positive patients hospitalized between 3/2020â€"8/2021 was manually chart-reviewed and classified as admitted-with-COVID-19 (incidental) vs. specifically admitted for COVID-19 (for-COVID-19). EHR-based phenotyped feature sets filtered out incidental admissions, which occurred in 26%. The top site-specific feature sets had 79-99% specificity with 62-75% sensitivity, while the best performing across-site feature set had 71-94% specificity with 69-81% sensitivity. A large proportion of SARS-CoV-2 PCR-positive admissions were incidental. Straightforward EHR-based phenotypes differentiated admissions, which is important to assure accurate public health reporting and research.