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[Preprint]. 2022 Feb 18:2022.02.10.22270728. [Version 2] doi: 10.1101/2022.02.10.22270728

Distinguishing Admissions Specifically for COVID-19 from Incidental SARS-CoV-2 Admissions: A National EHR Research Consortium Study

Jeffrey G Klann, Zachary H Strasser, Meghan R Hutch, Chris J Kennedy, Jayson S Marwaha, Michele Morris, Malarkodi Jebathilagam Samayamuthu, Ashley C Pfaff, Hossein Estiri, Andrew M South, Griffin M Weber, William Yuan, Paul Avillach, Kavishwar B Wagholikar, Yuan Luo; The Consortium for Clinical Characterization of COVID-19 by EHR (4CE), Gilbert S Omenn, Shyam Visweswaran, John H Holmes, Zongqi Xia, Gabriel A Brat, Shawn N Murphy
PMCID: PMC8963684  PMID: 35350202

Abstract

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 3/2020–8/2021 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.

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