2296. Trends in reasons for hospital admission among adults ≥18 years hospitalized with laboratory-confirmed SARS-CoV-2 infection—COVID-19-Associated Hospitalization Surveillance Network (COVID-NET), 14 U.S. States, June 2020 – January 2023
Authors: Havers Fiona P , Whitaker Michael , Patton Monica E , Melgar Michael , Reingold Art , Alden Nisha B , Kim Daewi , Openo Kyle P , Weigel Andy , Ryan Patricia A , Reeg Libby , Como-Sabetti Kathryn , Domen Adrienne , Barney Grant , Popham Kevin , Shiltz Eli , Sutton Melissa , Keipp Talbot H , Crossland Melanie , Taylor Christopher 
Published: November 2023

Abstract

Background
During the COVID-19 pandemic, hospitals performed widespread screening for SARS-CoV-2, resulting in identification of asymptomatic or mildly ill persons with SARS-CoV-2 who were admitted for other reasons. We examined trends in reasons for admission to identify hospitalized adults with a positive SARS-CoV-2 test likely admitted for COVID-19-related illness.

Methods
From June 2020–January 2023, hospitalized patients aged ≥ 18 years with a positive screening or clinician-directed SARS-CoV-2 test ≤ 14 days prior to or during hospitalization were identified from &gt; 300 hospitals across 14 states in the population-based COVID-19-Associated Hospitalization Surveillance Network. Trained staff abstracted charts for a representative sample of patients. COVID-19-related admissions were indicated if 1) COVID-19 or 2) COVID-19-associated symptoms or clinical presentations were listed as chief complaint or reason for admission in the history of present illness. Percentages for sampled cases were weighted to account for probability of selection.

Results
Among 424,047 adults hospitalized with SARS-CoV-2 infection, the proportion aged ≥ 75 years increased over time to &gt; 40% by October 2022 (Figure 1). The proportion of patients among 34,644 sampled hospitalizations admitted with likely COVID-19-related illness declined from 88.0% (June 1, 2020–June 19, 2021) to 72.4% (June 19, 2022–January 31, 2023) (Figure 2). The greatest decline in COVID-19-related admissions occurred in adults aged 18–49 years; the smallest decline occurred in adults aged ≥75 years: &gt; 80% of these admissions in all periods were likely COVID-19-related. Among adults hospitalized from June 2022–January 2023, 27.1% had non-COVID-19 reasons for admission, including planned procedures (2.4%), obstetrics labor and delivery (5.0%), psychiatric admission requiring acute medical care (2.5%), trauma (2.6%), and other reasons likely unrelated to COVID-19 (14.6%).Figure 1.Proportion of laboratory-confirmed SARS-CoV-2 infection-associated hospitalizations by adult age group, June 2020 – January 2023Figure 2.Proportions of hospitalized adults with laboratory-confirmed SARS-CoV-2 infection who had COVID-19 as a likely reason for admission, by age group and variant predominance period — COVID-NET, June 2020 – January 2023

Conclusion
While the proportion of COVID-19-related admissions decreased over time among patients hospitalized with laboratory-confirmed SARS-CoV-2, most adults with a positive SARS-CoV-2 test were likely admitted for reasons related to COVID-19. Misclassification of admission reason may occur.

Disclosures
Art Reingold, MD, GSK: Advisor/Consultant|Takeda: Advisor/Consultant|VBI: Advisor/Consultant