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Refining the hospitalization rate: A mixed methods approach to differentiate primary COVID-19 from incidental cases
M Misailovski1, D Koller2, S Blaschke3
1Department of Infectious Control and Infectious Diseases, University Medical Center Göttingen, Göttingen, Germany.
Insights
Differentiating primary COVID-19 hospitalizations from incidental cases is crucial for accurately measuring the healthcare burden. This study identifies key clinical parameters to refine the Hospitalization Rate (HR) indicator.
Area of Science:
- Healthcare epidemiology
- Infectious disease surveillance
- Clinical informatics
Background:
- The Hospitalization Rate (HR) is a key indicator for the COVID-19 healthcare burden.
- Accurate HR calculation requires distinguishing primary COVID-19 cases from incidental SARS-CoV-2 infections.
- Current HR metrics may not fully capture the true impact of COVID-19 on healthcare systems.
Purpose of the Study:
- To synthesize evidence on criteria differentiating primary COVID-19 hospitalizations from incidental cases.
- To identify parameters for improving the accuracy of the COVID-19 Hospitalization Rate.
- To enhance the utility of HR as a measure of COVID-19 associated healthcare burden.
Main Methods:
- Conducted an online survey among members of the German Network University Medicine (NUM).
- Performed qualitative, semi-structured interviews with senior clinicians specializing in COVID-19 care.
- Undertook a rapid literature review of publications from March 2020 to December 2022.
Main Results:
- Online survey identified pneumonia and respiratory infections as indicative of primary cases; malignancies and myocardial infarctions as incidental.
- Expert interviews highlighted diagnosis, ward, admission type, oxygen saturation, and COVID-19 therapy as primary case indicators.
- Literature review associated respiratory symptoms, oxygen support, and inflammatory markers with primary COVID-19 hospitalizations.
Conclusions:
- Established parameters can differentiate primary from incidental COVID-19 hospitalizations.
- An updated HR, incorporating these differentiation criteria, will provide a more accurate reflection of the COVID-19 healthcare burden.
- Improved HR metrics are essential for effective public health response and resource allocation.
Purpose:
Until now, the Hospitalization Rate (HR) served as an indicator (among others) for the COVID-19 associated healthcare burden. To ensure that the HR accomplishes its full potential, hospitalizations caused by COVID-19 (primary cases) and hospitalizations of patients with incidental positive SARS-CoV-2 test results (incidental cases) must be differentiated. The aim of this study was to synthesize the existing evidence on differentiation criteria between hospitalizations of primary cases and incidental cases.
Methods:
An online survey of the members of the German Network University Medicine (NUM) was conducted. Additionally, senior clinicians with expertise in COVID-19 care were invited for qualitative, semi-structured interviews. Furthermore, a rapid literature review was undertaken on publications between 03/2020 and 12/2022.
Results:
In the online survey (n=30, response rate 56%), pneumonia and acute upper respiratory tract infections were the most indicative diagnoses for a primary case. In contrast, malignant neoplasms and acute myocardial infarctions were most likely to be associated with incidental cases. According to the experts (n=6), the diagnosis, ward, and type of admission (emergency or elective), low oxygen saturation, need for supplemental oxygen, and initiation of COVID-19 therapy point to a primary case. The literature review found that respiratory syndromes and symptoms, oxygen support, and elevated levels of inflammatory markers were associated with primary cases.
Conclusion:
There are parameters for the differentiation of primary from incidental cases to improve the objective of the HR. Ultimately, an updated HR has the potential to serve as a more accurate indicator of the COVID-19 associated healthcare burden.
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