Refining the hospitalization rate: A mixed methods approach to differentiate primary COVID-19 from incidental cases
Infection Prevention in Practice, vol. 6, pp. 100371
Abstract
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.
Authors 17
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Universitätsmedizin Göttingen · University of Göttingen
Affiliation as printed
Department of Infectious Control and Infectious Diseases, University Medical Center Göttingen, Göttingen, Germany
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Daniela Koller corresponding
Institut für Medizinische Informationsverarbeitung, Biometrie und Epidemiologie · Ludwig-Maximilians-Universität München
Affiliation as printed
Institute of Medical Data Processing, Biometrics and Epidemiology, Faculty of Medicine, LMU Munich, Munich, Germany
Institute of Medical Data Processing, Biometrics and Epidemiology, Faculty of Medicine, LMU Munich, Munich Germany
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Universitätsmedizin Göttingen · University of Göttingen
Affiliation as printed
Emergency Department, University Medical Center Göttingen, 37075 Göttingen, Germany
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Universitätsmedizin Göttingen · University of Göttingen
Affiliation as printed
Department of Infectious Control and Infectious Diseases, University Medical Center Göttingen, Göttingen, Germany
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LMU Klinikum · Institut für Medizinische Informationsverarbeitung, Biometrie und Epidemiologie · Deutsches Schwindel- und Gleichgewichtszentrum · Ludwig-Maximilians-Universität München
Affiliation as printed
German Center for Vertigo and Balance Disorders, Faculty of Medicine, University Hospital, LMU Munich, Munich, Germany
Institute of Medical Data Processing, Biometrics and Epidemiology, Faculty of Medicine, LMU Munich, Munich, Germany
German Center for Vertigo and Balance Disorders, University Hospital, Ludwig-Maximilians- Universität München, Munich, Germany
Institute of Medical Data Processing, Biometrics and Epidemiology, Faculty of Medicine, LMU Munich, Munich Germany
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University Hospital Carl Gustav Carus · Technische Universität Dresden
Affiliation as printed
Department of Pediatrics, University Hospital and Medical Faculty Carl Gustav Carus, TUD Dresden University of Technology, Dresden, Germany
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Universitätsklinikum Aachen · RWTH Aachen University
Affiliation as printed
Institute of Pathology, RWTH Aachen University Hospital, Aachen, Germany
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Affiliation as printed
Infection Control and Antimicrobial Stewardship Unit, University Hospital Wuerzburg, Wuerzburg, Germany
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Universitätsklinikum Aachen · RWTH Aachen University
Affiliation as printed
Institute of Pathology, RWTH Aachen University Hospital, Aachen, Germany
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Affiliation as printed
Department of Medical Informatics, University Medical Center Göttingen, Göttingen, Germany
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Affiliation as printed
Infection Control and Antimicrobial Stewardship Unit, University Hospital Wuerzburg, Wuerzburg, Germany
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Affiliation as printed
Department of Paediatrics, University Hospital Wuerzburg, Wuerzburg, Germany
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Affiliation as printed
University Hospital Würzburg, Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, Würzburg, Germany
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University of Bonn · University Hospital Bonn
Affiliation as printed
Staff Unit for Scientific & Medical Technology Development & Coordination (MWTek), Commercial Directorate, University Hospital Bonn, Bonn, Germany
Synergy Research and Experimental Medicine Lab, Medical Clinic III, University Hospital Bonn, Bonn, Germany
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University of Bonn · University Hospital Bonn · Institut für Medizinische Biometrie, Informatik und Epidemiologie
Affiliation as printed
Applied Mathematical Physiology (AMP) Lab, Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
Applied Medical Informatics (AMI) Lab, Institute for Medical Biometry, Informatics & Epidemiology (IMBIE), University Hospital Bonn, Bonn, Germany
Staff Unit for Scientific & Medical Technology Development & Coordination (MWTek), Commercial Directorate, University Hospital Bonn, Bonn, Germany
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Universitätsmedizin Göttingen · University of Göttingen
Affiliation as printed
Department of Infectious Control and Infectious Diseases, University Medical Center Göttingen, Göttingen, Germany
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LMU Klinikum · Institut für Medizinische Informationsverarbeitung, Biometrie und Epidemiologie · Deutsches Schwindel- und Gleichgewichtszentrum · Ludwig-Maximilians-Universität München
Affiliation as printed
German Center for Vertigo and Balance Disorders, Faculty of Medicine, University Hospital, LMU Munich, Munich, Germany
Institute of Medical Data Processing, Biometrics and Epidemiology, Faculty of Medicine, LMU Munich, Munich, Germany
German Center for Vertigo and Balance Disorders, University Hospital, Ludwig-Maximilians- Universität München, Munich, Germany
Institute of Medical Data Processing, Biometrics and Epidemiology, Faculty of Medicine, LMU Munich, Munich Germany
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