Comparing automated vs. manual data collection for COVID-specific medications from electronic health records.

INTRODUCTION: Data extraction from electronic health record (EHR) systems occurs through manual abstraction, automated extraction, or a combination of both. While each method has its strengths and weaknesses, both are necessary for retrospective observational research as well as sudden clinical events, like the COVID-19 pandemic. Assessing the strengths, weaknesses, and potentials of these methods is important to continue to understand optimal approaches to extracting clinical data. We set out to assess automated and manual techniques for collecting medication use data in patients with COVID-19 to inform future observational studies that extract data from the electronic health record (EHR). MATERIALS AND METHODS: For 4,123 COVID-positive patients hospitalized and/or seen in the emergency department at an academic medical center between 03/03/2020 and 05/15/2020, we compared medication use data of 25 medications or drug classes collected through manual abstraction and automated extraction from the EHR. Quantitatively, we assessed concordance using Cohen's kappa to measure interrater reliability, and qualitatively, we audited observed discrepancies to determine causes of inconsistencies. RESULTS: For the 16 inpatient medications, 11 (69%) demonstrated moderate or better agreement; 7 of those demonstrated strong or almost perfect agreement. For 9 outpatient medications, 3 (33%) demonstrated moderate agreement, but none achieved strong or almost perfect agreement. We audited 12% of all discrepancies (716/5,790) and, in those audited, observed three principal categories of error: human error in manual abstraction (26%), errors in the extract-transform-load (ETL) or mapping of the automated extraction (41%), and abstraction-query mismatch (33%). CONCLUSION: Our findings suggest many inpatient medications can be collected reliably through automated extraction, especially when abstraction instructions are designed with data architecture in mind. We discuss quality issues, concerns, and improvements for institutions to consider when crafting an approach. During crises, institutions must decide how to allocate limited resources. We show that automated extraction of medications is feasible and make recommendations on how to improve future iterations.

The Role of Disease Severity and Demographics in the Clinical Course of COVID-19 Patients Treated With Convalescent Plasma.

Treatment of patients with COVID-19 using convalescent plasma from recently recovered patients has been shown to be safe, but the time course of change in clinical status following plasma transfusion in relation to baseline disease severity has not yet been described. We analyzed short, descriptive daily reports of patient status in 7,180 hospitalized recipients of COVID-19 convalescent plasma in the Mayo Clinic Expanded Access Program. We assessed, from the day following transfusion, whether the patient was categorized by his or her physician as better, worse or unchanged compared to the day before, and whether, on the reporting day, the patient received mechanical ventilation, was in the ICU, had died or had been discharged. Most patients improved following transfusion, but clinical improvement was most notable in mild to moderately ill patients. Patients classified as severely ill upon enrollment improved, but not as rapidly, while patients classified as critically ill/end-stage and patients on ventilators showed worsening of disease status even after treatment with convalescent plasma. Patients age 80 and over showed little or no clinical improvement following transfusion. Clinical status at the time of convalescent plasma treatment and age appear to be the primary factors in determining the therapeutic effectiveness of COVID-19 convalescent plasma among hospitalized patients.

Bronchopulmonary dysplasia patients have preserved CT-measured central airway luminal area.

Bronchopulmonary dysplasia (BPD) is a condition of neonatal chronic lung disease due to disruption or dysregulation of pulmonary development. However, the pathophysiology of BPD in the larger conducting airways is not yet fully understood. The objective of our study was to determine if the area of the central airways are altered in patients with a history of BPD. We hypothesized that compared to age- and sex-matched controls, BPD patients would have decreased area of the central conducting airways. Twenty-two BPD patients (n = 10 male, n = 12 female; median age = 10 [range:1-49] yrs) and n = 22 matched controls (n = 10 male, n = 12 female; median age = 10 [range:1-48] yrs) who had undergone a chest computed tomography (CT) scan were retrospectively identified. Measurement and analysis was performed using software that reconstructs the airways into 3D. Measurements of airway area were conducted at three points based on anatomic bifurcations for each of the following structures: trachea, left main bronchus, left upper lobe, left lower lobe, right main bronchus, intermediate bronchus, and right upper lobe. The luminal area for each airway was calculated based on the averages of the three measures. Airway luminal area was not different between BPD patients and matched controls for any of the measured airways (p > 0.05). Total lung volume detected in the CT scans was not different between BPD patients and matched controls (median [range]; 2775 [522-6215] vs 2969 [851-5612] cm3, p > 0.05). Our results suggest the luminal areas of the large conducting airways in patients with BPD are not different from matched controls.

Efficacy of Cell-Based Therapies for Traumatic Brain Injuries.

Traumatic brain injuries (TBIs) are a leading cause of death and disability. Additionally, growing evidence suggests a link between TBI-induced neuroinflammation and neurodegenerative disorders. Treatments for TBI patients are limited, largely focused on rehabilitation therapy, and ultimately, fail to provide long-term neuroprotective or neurorestorative benefits. Because of the prevalence of TBI and lack of viable treatments, new therapies are needed which can promote neurological recovery. Cell-based treatments are a promising avenue because of their potential to provide multiple therapeutic benefits. Cell-based therapies can promote neuroprotection via modulation of inflammation and promote neurorestoration via induction of angiogenesis and neurogenesis. Neural stem/progenitor cell transplantations have been investigated in preclinical TBI models for their ability to directly contribute to neuroregeneration, form neural-like cells, and improve recovery. Mesenchymal stem cells (MSCs) have been investigated in clinical trials through multiple different routes of administration. Intravenous administration of MSCs appears most promising, demonstrating a robust safety profile, correlation with neurological improvements, and reductions in systemic inflammation following TBI. While still preliminary, evidence suggests cell-based therapies may become a viable treatment for TBI based on their ability to promote neuroregeneration and reduce inflammation.