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CSTE National ELR Workgroup

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Becky Lampkins, Manager, Surveillance/Informatics Program at CSTEMegan Toe, CSTEScott Troppy, Surveillance Epidemiologist at MA DPHMeredith Lichtenstein, CSTEAmy Drake, NMJohn RobertsNancy Barrett, Epi 4/PH Informatics SpecialistErin Holt, TDHRita Altamore, EpidemiologistDavid DiCesareJason HallWalter Kemper, ELR Coordinator, NC DHHS Div of Public HealthJulie LuepkeCarmen Pugh, Labcorp Manager State Reporting at LabCorpTom Safranek +399 others
Posted by Brooke Beaulieu ·

AOE Question Clarifications

Hi all,

On today's ELDR subcommittee call, we posed the following questions related to clarifying the intent and interpretation of the AOE questions included in the HHS Lab Reporting guidance. We captured some feedback on the call, and are posting here in case anyone else want to comment. We appreciate whatever insight you can provide!

  1. First test (Y/N/U
    • Does this refer exclusively to the type of test being ordered? E.g. if a provider is ordering a COVID-19 serology test, but the patient has had a PCR test done in the past, would we say Y or N?
    • Is it reasonable to assume that this is “first test known to this organization?” since it’s possible that the patient has had other tests through other means (e.g. walk-up clinics, or at a separate ED, etc.)
  2. Symptomatic as defined by CDC? Y/N/U; if yes, then Date of Symptom Onset mm/dd/yy
    • Currently symptomatic or ever symptomatic (within the past x # of days/weeks)?
  3. Hospitalized? Y/N/U
    • Does this refer to if the patient is currently hospitalized or hospitalized within the past # of days/weeks?
    • Should this only be answered Y if patient is in the hospital for COVID-19 symptoms? Hospitals may be screening all inpatients, whether they're in for suspected COVID-19 or a cardiac problem.
  4. ICU? Y/N/U
    • Does this refer to if the patient is currently in the ICU or has been in the ICU within the past # of days/weeks?
    • Should this only be answered Y if patient is in the ICU for COVID-19 symptoms?

Comments & Events

Sita Smith Sita Smith
Thoughts from Massachusetts:

1.     First test (Y/N/U

We would think what would make sense is for this to be  “Yes” if it is first positive reported to the health department by that organization, regardless of type (which we will know because they are reporting the test and result).That seems to me like what we’re driving at here, right? This covers the eventuality that they may have had past results reported by other organizations. Although honestly, I’m not 100% sure what we’re going for analyzing on here.
2.     Symptomatic as defined by CDC? Y/N/U; if yes, then Date of Symptom Onset mm/dd/yy

Both are interesting questions. We want to know symptom onset regardless of the way the first question is asked. 
For the first question traditionally we have gone with ever symptomatic, within an incubation period. However the question of if they are symptomatic at the time of specimen collection might inform issues of false negatives, and could be especially relevant for collection of serologies post symptomatic period. We almost want to ask both – currently symptomatic and ever symptomatic.
3.     Hospitalized? Y/N/U

We think this should be currently hospitalized. We wouldn’t really want to be getting hospitalization information from a lab that is not the hospital where the case was hospitalized. Hospitalizations should be for COVID-19 symptoms or complications, and should be only for individuals admitted >24 hours.
4.     ICU? Y/N/U

Again we would vote for currently being in the ICU, and only for COVID-19.
For both of the last two, and really in general,  we would think the idea is to get at relative severity at the time of collection, as opposed to risk history of the case.
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