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Using EHR data to identify coronavirus infections in hospitalized patients: Impact of case definitions on disease

Ann Marie Navar1, Irene Cosmatos2, Stacey Purinton3

  • 1University of Texas Southwestern Medical Center, Dallas, TX, United States.

International Journal of Medical Informatics
|August 21, 2022
PubMed

Insights

COVID-19 case definitions significantly impact hospitalization numbers and patient characteristics. Laboratory confirmation revealed differences in race, ethnicity, insurance, treatments, and mortality compared to clinical diagnoses alone.

Area of Science:

  • Infectious Diseases
  • Epidemiology
  • Health Services Research

Background:

  • Accurate case identification is crucial for understanding disease burden and outcomes.
  • Coronavirus disease 2019 (COVID-19) diagnosis relies on both laboratory testing and clinical assessment.
  • Variations in case definitions can influence epidemiological data and clinical trial eligibility.

Purpose of the Study:

  • To compare the number, characteristics, and outcomes of hospitalized COVID-19 patients using two distinct case definitions.
  • To analyze disparities in patient demographics, treatments, and complications based on diagnostic criteria.
  • To highlight the impact of case definition on the perceived burden of COVID-19 hospitalizations.

Main Methods:

  • Retrospective analysis of Electronic Health Record data from 52 US health systems.
  • Inclusion of patients hospitalized with COVID-19 through May 2020.
  • Comparison of patients with laboratory-confirmed SARS-CoV-2 infection versus those with a clinical diagnosis only.

Main Results:

  • Of 14,371 inpatients, 46.1% had laboratory-confirmed COVID-19 and 52.9% had a clinical diagnosis.
  • Laboratory-confirmed cases differed in race, ethnicity, and insurance status compared to clinically diagnosed cases.
  • Laboratory-confirmed COVID-19 patients received more specific therapies but had higher overall mortality and fewer complications like myocardial infarction.

Conclusions:

  • The choice of case definition for COVID-19 hospitalizations can lead to a two-fold difference in patient numbers.
  • Variations in case definitions affect the observed cohort characteristics, treatment patterns, and patient outcomes.
  • Standardizing case definitions is essential for accurate COVID-19 surveillance and research.
Abstract

Keywords:
COVID-19Case definitionElectronic health records

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