Impact of changing case definitions for coronavirus disease 2019 (COVID-19) hospitalization on pandemic metrics

作者：Claire Shappell, Michael Klompas, Christina K. Chan, Tom Chen, Chanu Rhee · 发表于：Infection Control and Hospital Epidemiology · 年份：2023 · DOI：10.1017/ice.2022.300 · 被引用次数：7 · 研究领域：COVID-19 Clinical Research Studies、COVID-19 and healthcare impacts、SARS-CoV-2 detection and testing

Abstract Objective: To examine the impact of commonly used case definitions for coronavirus disease 2019 (COVID-19) hospitalizations on case counts and outcomes. Design, patients, and setting: Retrospective analysis of all adults hospitalized between March 1, 2020, and March 1, 2022, at 5 Massachusetts acute-care hospitals. Interventions: We applied 6 commonly used definitions of COVID-19 hospitalization: positive severe acute respiratory coronavirus virus 2 (SARS-CoV-2) polymerase chain reaction (PCR) assay within 14 days of admission, PCR plus dexamethasone administration, PCR plus remdesivir, PCR plus hypoxemia, institutional COVID-19 flag, or COVID-19 International Classification of Disease, Tenth Revision (ICD-10) codes. Outcomes included case counts and in-hospital mortality. Overall, 100 PCR-positive cases were reviewed to determine each definition’s accuracy for distinguishing primary or contributing versus incidental COVID-19 hospitalizations. Results: Of 306,387 hospital encounters, 15,436 (5.0%) met the PCR-based definition. COVID-19 hospitalization counts varied substantially between definitions: 4,628 (1.5% of all encounters) for PCR plus dexamethasone, 5,757 (1.9%) for PCR plus remdesivir, 11,801 (3.9%) for PCR plus hypoxemia, 15,673 (5.1%) for institutional flags, and 15,868 (5.2%) for ICD-10 codes. Definitions requiring dexamethasone, hypoxemia, or remdesivir selected sicker patients compared to PCR alone (mortality rates 12.2%, 10.7%, and 8.8% vs 8.3%, respec...