Department of Population Medicine, Harvard Medical School/Harvard Pilgrim Health Care Institute, Boston, Massachusetts.
Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
Infect Control Hosp Epidemiol. 2023 Sep;44(9):1458-1466. doi: 10.1017/ice.2022.300. Epub 2023 Mar 13.
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.
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 (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.
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%, respectively). Definitions requiring PCR plus remdesivir or dexamethasone did not detect a reduction in in-hospital mortality associated with the SARS-CoV-2 Omicron variant. ICD-10 codes had the highest sensitivity (98.4%) but low specificity (39.5%) for distinguishing primary or contributing versus incidental COVID-19 hospitalizations. PCR plus dexamethasone had the highest specificity (92.1%) but low sensitivity (35.5%).
Commonly used definitions for COVID-19 hospitalizations generate variable case counts and outcomes and differentiate poorly between primary or contributing versus incidental COVID-19 hospitalizations. Surveillance definitions that better capture and delineate COVID-19-associated hospitalizations are needed.
研究常用于 2019 年冠状病毒病（COVID-19）住院的病例定义对病例计数和结果的影响。
设计、患者和地点：对 2020 年 3 月 1 日至 2022 年 3 月 1 日在马萨诸塞州 5 家急性护理医院住院的所有成年人进行回顾性分析。
我们应用了 6 种常用于 COVID-19 住院的定义：入院后 14 天内进行的严重急性呼吸冠状病毒 2（SARS-CoV-2）聚合酶链反应（PCR）检测呈阳性、PCR 加地塞米松治疗、PCR 加瑞德西韦、PCR 加低氧血症、机构 COVID-19 标志或 COVID-19（ICD-10）代码。结果包括病例计数和院内死亡率。总体而言，我们回顾了 100 例 PCR 阳性病例，以确定每种定义对区分原发性或主要贡献性 COVID-19 住院与偶发性 COVID-19 住院的准确性。
在 306387 例住院治疗中，有 15436 例（5.0%）符合基于 PCR 的定义。COVID-19 住院患者的数量因定义而异：PCR 加地塞米松治疗为 4628 例（占所有病例的 1.5%）、PCR 加瑞德西韦治疗为 5757 例（1.9%）、PCR 加低氧血症为 11801 例（3.9%）、机构标志为 15673 例（5.1%）、ICD-10 代码为 15868 例（5.2%）。需要地塞米松、低氧血症或瑞德西韦的定义选择了比单独 PCR 更严重的患者（死亡率分别为 12.2%、10.7%和 8.8%）。需要 PCR 加瑞德西韦或地塞米松的定义并未发现与 SARS-CoV-2 奥密克戎变体相关的住院死亡率降低。ICD-10 代码在区分原发性或主要贡献性 COVID-19 住院与偶发性 COVID-19 住院方面具有最高的敏感性（98.4%），但特异性（39.5%）较低。PCR 加地塞米松具有最高的特异性（92.1%），但敏感性（35.5%）较低。
常用于 COVID-19 住院的定义会产生不同的病例计数和结果，并且在区分原发性或主要贡献性 COVID-19 住院与偶发性 COVID-19 住院方面效果不佳。需要更好地捕获和描述 COVID-19 相关住院的监测定义。
