medRxiv. 2020 Dec 7:2020.12.04.20244137. doi: 10.1101/2020.12.04.20244137. Preprint.
Using structured elements from Electronic Health Records (EHR), we seek to: i ) build predictive models to stratify patients tested for COVID-19 by their likelihood for hospitalization, ICU admission, mechanical ventilation and inpatient mortality, and ii ) identify the most important EHR-based features driving the predictions. We leveraged EHR data from the Duke University Health System tested for COVID-19 or hospitalized between March 11, 2020 and August 24, 2020, to build models to predict hospital admissions within 4 weeks. Models were also created for ICU admissions, need for mechanical ventilation and mortality following admission. Models were developed on a cohort of 86,355 patients with 112,392 outpatient COVID-19 tests or any-cause hospital admissions between March 11, 2020 and June 4, 2020. The four models considered resulted in AUROC=0.838 (CI: 0.832-0.844) and AP=0.272 (CI: 0.260-0.287) for hospital admissions, AUROC=0.847 (CI: 0.839-855) and AP=0.585 (CI: 0.565-0.603) for ICU admissions, AUROC=0.858 (CI: 0.846-0.871) and AP=0.434 (CI: 0.403-0.467) for mechanical ventilation, and AUROC=0.0.856 (CI: 0.842-0.872) and AP=0.243 (CI: 0.205-0.282) for inpatient mortality. Patient history abstracted from the EHR has the potential for being used to stratify patients tested for COVID-19 in terms of utilization and mortality. The dominant EHR features for hospital admissions and inpatient outcomes are different. For the former, age, social indicators and previous utilization are the most important predictive features. For the latter, age and physiological summaries (pulse and blood pressure) are the main drivers.