Comparing COVID-19 and Influenza Presentation and Trajectory

Background: COVID-19 is a newly recognized illness with a predominantly respiratory presentation. It is important to characterize the differences in disease presentation and trajectory between COVID-19 patients and other patients with common respiratory illnesses. These differences can enhance knowledge of pathogenesis and help in guiding treatment.Methods: Data from electronic medical records were obtained from individuals admitted with respiratory illnesses to Rambam Health Care Campus, Haifa, Israel, between October 1st, 2014 and October 1st, 2020. Four groups of patients were defined: COVID-19 (693), influenza (1,612), severe acute respiratory infection (SARI) (2,292), and Others (4,054). The variable analyzed include demographics (7), vital signs (8), lab tests (38), and comorbidities (15) from a total of 8,651 hospitalized adult patients. Statistical analysis was performed on biomarkers measured at admission and for their disease trajectory in the first 48 h of hospitalization, and on comorobidity prevalence.Results: COVID-19 patients were overall younger in age and had higher body mass index, compared to influenza and SARI. Comorbidity burden was lower in the COVID-19 group compared to influenza and SARI. Severely- and moderately-ill COVID-19 patients older than 65 years of age suffered higher rate of in-hospital mortality compared to hospitalized influenza patients. At admission, white blood cells and neutrophils were lower among COVID-19 patients compared to influenza and SARI patients, while pulse rate and lymphoctye percentage were higher. Trajectories of variables during the first 2 days of hospitalization revealed that white blood count, neutrophils percentage and glucose in blood increased among COVID-19 patients, while decreasing among other patients.Conclusions: The intrinsic virulence of COVID-19 appeared higher than influenza. In addition, several critical functions, such as immune response, coagulation, heart and respiratory function, and metabolism were uniquely affected by COVID-19.

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At the dawn of winter: comparing COVID-19 and influenza presentation and trajectory

10.1101/2020.11.19.20235077 ◽

2020 ◽

Author(s):

Anat Reiner Benaim ◽

Jonathan Aryeh Sobel ◽

Ronit Almog ◽

Snir Lugassy ◽

Tsviel Ben Shabbat ◽

...

Keyword(s):

Electronic Medical Records ◽

Medical Records ◽

Acute Respiratory Infection ◽

White Blood Cells ◽

Vital Signs ◽

White Blood Count ◽

Respiratory Illnesses ◽

Disease Trajectory ◽

Severe Acute Respiratory Infection ◽

Comorbidity Burden

BackgroundCOVID-19 is a newly recognized illness with a predominantly respiratory presentation. As winter approaches in the northern hemisphere, it is important to characterize the differences in disease presentation and trajectory between COVID-19 patients and other patients with common respiratory illnesses. These differences can enhance knowledge of pathogenesis and help in guiding treatment.MethodsData from electronic medical records were obtained from individuals admitted with respiratory illnesses to Rambam Health Care Campus, Haifa, Israel, between October 1st, 2014 and September 1st, 2020. Four groups of patients were defined: COVID-19 (693), influenza (1,612), severe acute respiratory infection (SARI) (2,292) and Others (4,054). The variable analyzed include demographics (7), vital signs (8), lab tests (38), and comorbidities (15) from a total of 8,651 hospitalized adult patients. Statistical analysis was performed on biomarkers measured at admission and for their disease trajectory in the first 48 hours of hospitalization, and on comorobidity prevalence.ResultsCOVID-19 patients were overall younger in age and had higher body mass index, compared to influenza and SARI. Comorbidity burden was lower in the COVID-19 group compared to influenza and SARI. Severely- and moderately-ill COVID-19 patients older than 65 years of age suffered higher rate of in-hospital mortality compared to hospitalized influenza patients. At admission, white blood cells and neutrophils were lower among COVID-19 patients compared to influenza and SARI patients, while pulse rate and lymphoctye percentage were higher. Trajectories of variables during the first two days of hospitalization revealed that white blood count, neutrophils percentage and glucose in blood increased among COVID-19 patients, while decreasing among other patients.ConclusionsThe intrinsic virulence of COVID-19 appeared higher than influenza. In addition, several critical functions, such as immune response, coagulation, heart and respiratory function and metabolism were uniquely affected by COVID-19.

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883 A Closed-Loop Audit to Improve Admissions Documentation in A Busy ENT Department

British Journal of Surgery ◽

10.1093/bjs/znab259.108 ◽

2021 ◽

Vol 108 (Supplement_6) ◽

Author(s):

A Connelly ◽

K Law ◽

A Williamson

Keyword(s):

Electronic Medical Records ◽

Medical Records ◽

Closed Loop ◽

Vital Signs ◽

P Value ◽

Medication History ◽

Admission Source ◽

Effective Care ◽

User Friendly ◽

Pro Forma

Abstract Aim Accurate and thorough admissions documentation is crucial for patient safety and effective care. We amended the admissions pro-forma used on a busy adult ENT ward to improve adherence to a modified version of Royal College of Surgeons of England guidelines. Method Baseline documentation of the 25 parameters of interest was assessed using electronic medical records for all emergency and pre-operative admissions over a 4-week period (n = 75). A new pro-forma was introduced, and the documentation over the following 4 weeks (n = 75) was assessed in the same way. Statistical analysis was done using Excel and RStudio (z-test for two proportions, p-value ≤ 0.05). Results The two groups were similar in age, gender, length of stay, and presenting complaint. The new pro-forma was completed for more admissions than the prior version (91% vs 77%) and resulted in documentation improvements in 19 out of 25 parameters. 9 of these were statistically significant, including initial vital signs and differential diagnosis. Parameters that improved, but not significantly, include admission source, medication history, and cognitive assessment. Across the 8 weeks, using a pro-forma (n = 126) significantly improved documentation of 11 parameters compared to freehand clerking (n = 24). Conclusions Adequate documentation at admission can help with immediate patient care, and act as a point of reference during extended stays. We were able to increase use of a pro-forma and produce meaningful documentation improvements quickly. Further work is required to assess why certain parameters are infrequently completed, and how future pro-forma iterations can become more user-friendly.

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Design of cyber-physical interface for automated vital signs reading in electronic medical records systems

2012 IEEE International Conference on Electro/Information Technology ◽

10.1109/eit.2012.6220696 ◽

2012 ◽

Cited By ~ 8

Author(s):

Eduardo Ojeda Mendez ◽

Shangping Ren

Keyword(s):

Electronic Medical Records ◽

Medical Records ◽

Vital Signs ◽

Medical Records Systems

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Improving postpartum hemorrhage risk prediction using longitudinal electronic medical records

10.1101/2021.03.16.21253746 ◽

2021 ◽

Author(s):

Amanda B Zheutlin ◽

Luciana Vieira ◽

Shilong Li ◽

Zichen Wang ◽

Emilio Schadt ◽

...

Keyword(s):

Electronic Medical Records ◽

Postpartum Hemorrhage ◽

Medical Records ◽

Assessment Tool ◽

Vital Signs ◽

Area Under The Curve ◽

Test Sample ◽

Feature Model ◽

Gradient Boosting ◽

Clinical Feature

ABSTRACTObjectivePostpartum hemorrhage (PPH) remains a leading cause of preventable maternal mortality in the US. Our goal was to develop a novel risk assessment tool and compare its accuracy to those used in current practice.Materials and MethodsWe used a PPH digital phenotype we developed and validated previously to identify 6,639 cases from our delivery cohort (N=70,948). Using a vast array of known and potential risk factors extracted from electronic medical records available prior to delivery, we trained a gradient boosting model in a subset of our cohort. In a held-out test sample, we compared performance of our model to three clinical risk tools and one previously published model.ResultsOur 24-feature model achieved an area under the curve (AUC) of 0.71 (95% confidence interval [CI], 0.69-0.72), higher than all other tools (research-based AUC: 0.67 [95%CI, 0.66-0.69], clinical AUCs: 0.55 [95%CI, 0.54-0.56] to 0.61 [95%CI, 0.59-0.62]). Five features were novel including red blood cell indices and infection markers measured standardly upon admission. Additionally, we identified inflection points for several vital signs and labs where risk rose substantially. Most notably, patients with median intrapartum systolic blood pressure above 132mmHg had an 11% [interquartile range, 4%] median increase in relative risk for PPH.ConclusionsWe developed a novel approach for predicting PPH and identified clinical feature thresholds that can guide intrapartum monitoring for PPH risk. Our results suggest our model is an excellent candidate for prospective evaluation and could ultimately reduce PPH morbidity and mortality through early detection and prevention.

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