INTRODUCTION
During the COVID-19 pandemic, inpatient electronic health records (EHRs) have been used to conduct public health surveillance and assess treatments and outcomes. Invasive mechanical ventilation (MV) and supplemental oxygen (O) use are markers of severe illness in hospitalized COVID-19 patients. In a large US system (n = 142 hospitals), we assessed documentation of MV and O use during COVID-19 hospitalization in administrative data versus nursing documentation.
METHODS
We identified 319 553 adult hospitalizations with a COVID-19 diagnosis, February 2020-October 2022, and extracted coded, administrative data for MV or O. Separately, we developed classification rules for MV or O supplementation from semi-structured nursing documentation. We assessed MV and O supplementation in administrative data versus nursing documentation and calculated ordinal endpoints of decreasing COVID-19 disease severity. Nursing documentation was considered the gold standard in sensitivity and positive predictive value (PPV) analyses.
RESULTS
In nursing documentation, the prevalence of MV and O supplementation among COVID-19 hospitalizations was 14% and 75%, respectively. The sensitivity of administrative data was 83% for MV and 41% for O, with both PPVs above 91%. Concordance between sources was 97% for MV (κ = 0.85), and 54% for O (κ = 0.21). For ordinal endpoints, administrative data accurately identified intensive care and MV but underestimated hospitalizations with O requirements (42% vs. 18%).
CONCLUSIONS
In comparison to nursing documentation, administrative data under-ascertained O supplementation but accurately estimated severe endpoints such as MV. Nursing documentation improved ascertainment of O among COVID-19 hospitalizations and can capture oxygen requirements in adults hospitalized with COVID-19 or other respiratory illnesses.