PLoS ONE (Jan 2023)

Comparing methods to classify admitted patients with SARS-CoV-2 as admitted for COVID-19 versus with incidental SARS-CoV-2: A cohort study.

  • Corinne M Hohl,
  • Amber Cragg,
  • Elizabeth Purssel,
  • Finlay A McAlister,
  • Daniel K Ting,
  • Frank Scheuermeyer,
  • Maja Stachura,
  • Lars Grant,
  • John Taylor,
  • Josephine Kanu,
  • Jeffrey P Hau,
  • Ivy Cheng,
  • Clare L Atzema,
  • Rajan Bola,
  • Laurie J Morrison,
  • Megan Landes,
  • Jeffrey J Perry,
  • Rhonda J Rosychuk,
  • Canadian COVID-19 Emergency Department Rapid Response Network (CCEDRRN) investigators for the Network of Canadian Emergency Researchers,
  • Canadian Critical Care Trials Group

DOI
https://doi.org/10.1371/journal.pone.0291580
Journal volume & issue
Vol. 18, no. 9
p. e0291580

Abstract

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IntroductionNot all patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection develop symptomatic coronavirus disease 2019 (COVID-19), making it challenging to assess the burden of COVID-19-related hospitalizations and mortality. We aimed to determine the proportion, resource utilization, and outcomes of SARS-CoV-2 positive patients admitted for COVID-19, and assess the impact of using the Center for Disease Control's (CDC) discharge diagnosis-based algorithm and the Massachusetts state department's drug administration-based classification system on identifying admissions for COVID-19.MethodsIn this retrospective cohort study, we enrolled consecutive SARS-CoV-2 positive patients admitted to one of five hospitals in British Columbia between December 19, 2021 and May 31,2022. We completed medical record reviews, and classified hospitalizations as being primarily for COVID-19 or with incidental SARS-CoV-2 infection. We applied the CDC algorithm and the Massachusetts classification to estimate the difference in hospital days, intensive care unit (ICU) days and in-hospital mortality and calculated sensitivity and specificity.ResultsOf 42,505 Emergency Department patients, 1,651 were admitted and tested positive for SARS-CoV-2, with 858 (52.0%, 95% CI 49.6-54.4) admitted for COVID-19. Patients hospitalized for COVID-19 required ICU admission (14.0% versus 8.2%, pConclusionHalf of SARS-CoV-2 hospitalizations were for COVID-19 during the Omicron wave. The CDC algorithm was more specific and sensitive than the Massachusetts classification, but underestimated the burden of COVID-19 admissions.Trial registrationClinicaltrials.gov, NCT04702945.