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The Relationship Between the Ordering of a Respiratory Viral Panel and the Presence of Acute Respiratory Illness and Influenza-like Illness Symptoms Reported in the Electronic Medical Record

Saul, Sean/G (2020) The Relationship Between the Ordering of a Respiratory Viral Panel and the Presence of Acute Respiratory Illness and Influenza-like Illness Symptoms Reported in the Electronic Medical Record. Master's Thesis, University of Pittsburgh. (Unpublished)

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Abstract

Background: Influenza causes a large burden of hospitalizations in the United States (U.S.) each year. Influenza can lead to viral or bacterial pneumonia, dehydration, ear infections, and sinus infections, while serious complications can include inflammation of the heart (myocarditis), brain (encephalitis) or muscle (myositis, rhabdomyolysis) tissues, and multi-organ failure (for example, respiratory and kidney failure). Efficient mechanisms to accurately and quickly identify Influenza are needed, especially with respect to those with more severe illness.
Methods: Chart reviews were conducted on a random sample of 1,029 patients appearing on a clinical informatics algorithm (CIA) generated list from 12/1/15 to 5/11/16. This list was used for recruitment in the HAIVEN study which is a Centers for Disease Control and Prevention (CDC)–funded, multicenter, test-negative, case-control study to determine the Influenza vaccine effectiveness (VE) against hospitalization. The CIA queried medical record databases of patients who were 18 years of age and older admitted to University of Pittsburgh Medical Center (UPMC) St. Margaret’s Hospital in the previous 3 days using specified terms and diagnosis codes located in admission notes, emergency department notes, chief complaint upon registration, or presence of a respiratory viral panel charge (RVP). Using chart review data, each patient was deemed eligible for the study using 2 CDC descriptive eligibility boxes that aim to identify Acute Respiratory Illness (ARI) and Influenza-like Illness (ILI) using specified symptom-based and diagnosis-based terms. A Kappa test determined agreement between having a term listed on these eligibility boxes and RVP status. Binary and multivariate logistic regression tests were used to characterize the clinical features of those missed by the clinical RVP approach but found by the CDC’s screening criteria and to characterize the clinical features of those missed by the CDC’s screening criteria but found by the clinical RVP approach.
Results: Of the 1,029 patients reviewed, 290 patients met the eligibility criteria and received an RVP ordered by a physician and 201 met the eligibility criteria but did not have an RVP ordered by a physician. A Kappa test resulted in a weak agreement between the 2 descriptive eligibly boxes and RVPs (kappa=.43). Both RVP status and the CDC’s criteria were statistically significantly associated with fever, chest x-ray, and CT-scan.
Conclusion: The findings of this study suggest that physicians are ordering RVPs for ILI only moderately well and improvement through standardized ordering criteria may be needed. Using a CIA for recruitment for Influenza and other respiratory diseases studies was beneficial. The regression model further confirmed these findings. A hybrid case definition for inpatient Influenza may be needed.
Public Health Statement: The likelihood of being diagnosed with ARI or ILI by RVP was significantly higher if a patient had fever, chest x-ray, or CT-scan indicated. The likelihood of meeting the CDC’s criteria was significantly higher if a patient had fever, chest x-ray, or lymphocyte count indicated in the EMR.


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Details

Item Type: University of Pittsburgh ETD
Status: Unpublished
Creators/Authors:
CreatorsEmailPitt UsernameORCID
Saul, Sean/Gses164@pitt.eduses1640000-0003-0304-4001
ETD Committee:
TitleMemberEmail AddressPitt UsernameORCID
Committee ChairFrank, Linda/Rfrankie@pitt.edufrankie
Committee MemberNowalk, Mary/Pnowalkmp@upmc.eduTNOWALK
Committee MemberYassin, Mohamed/Hmhy8@pitt.edumhy8
Date: 30 July 2020
Date Type: Publication
Defense Date: 18 February 2020
Approval Date: 30 July 2020
Submission Date: 18 November 2019
Access Restriction: 2 year -- Restrict access to University of Pittsburgh for a period of 2 years.
Number of Pages: 55
Institution: University of Pittsburgh
Schools and Programs: Graduate School of Public Health > Infectious Diseases and Microbiology
Degree: MPH - Master of Public Health
Thesis Type: Master's Thesis
Refereed: Yes
Uncontrolled Keywords: influenza, flu, RVP, respiratory viral panel
Date Deposited: 30 Jul 2020 17:41
Last Modified: 30 Jul 2020 17:41
URI: http://d-scholarship.pitt.edu/id/eprint/37807

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