Volume 95, Issue 6
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645



The 2014 Ebola epidemic has shown the importance of accurate and rapid triage tools for patients with suspected Ebola virus disease (EVD). Our objective was to create a predictive score for EVD. We retrospectively reviewed all suspected cases admitted to the Ebola treatment center (ETC) in Nzérékoré, Guinea, between December 2, 2014, and February 23, 2015. We used a multivariate logistic regression model to identify clinical and epidemiological factors associated with EVD, which were used to create a predictive score. A bootstrap sampling method was applied to our sample to determine characteristics of the score to discriminate EVD. Among the 145 patients included in the study (48% male, median age 29 years), EVD was confirmed in 76 (52%) patients. One hundred and eleven (77%) patients had at least one epidemiological risk factor. Optimal cutoff value of fever to discriminate EVD was 38.5°C. After adjustment on presence of a risk factor, temperature higher than 38.5°C (odds ratio [OR] = 18.1, 95% confidence interval [CI] = 7.6–42.9), and anorexia (OR = 2.5, 95% CI = 1.1–6.1) were independently associated with EVD. The score had an area under curve of 0.85 (95% CI = 0.78–0.91) for the prediction of laboratory-confirmed EVD. Classification of patients in a high-risk group according to the score had a lower sensitivity (71% versus 86%) but higher specificity (85% versus 41%) than the existing World Health Organization algorithm. This score, which requires external validation, may be used in high-prevalence settings to identify different levels of risk in EVD suspected patients and thus allow a better orientation in different wards of ETC.


Article metrics loading...

The graphs shown below represent data from March 2017
Loading full text...

Full text loading...



  1. World Health Organization, 2015. Ebola Situation Reports. Available at: http://apps.who.int/ebola/ebola-situation-reports. Accessed September 6, 2015. [Google Scholar]
  2. MacNeil A, Farnon EC, Morgan OW, Gould P, Boehmer TK, Blaney DD, Wiersma P, Tappero JW, Nichol ST, Ksiazek TG, Rollin PE, , 2011. Filovirus outbreak detection and surveillance: lessons from Bundibugyo. J Infect Dis 204 (Suppl 3): S761S767.[Crossref] [Google Scholar]
  3. Kortepeter MG, Bausch DG, Bray M, , 2011. Basic clinical and laboratory features of filoviral hemorrhagic fever. J Infect Dis 204 (Suppl 3): S810S816.[Crossref] [Google Scholar]
  4. Barry M, Touré A, Traoré FA, Sako F-B, Sylla D, Kpamy DO, Bah EI, Bangoura M, Poncin M, Keita S, Tounkara TM, Cisse M, Vanhems P, , 2015. Clinical predictors of mortality in patients with Ebola virus disease. Clin Infect Dis 60: 18211824.[Crossref] [Google Scholar]
  5. Qin E, Bi J, Zhao M, Wang Y, Guo T, Yan T, Li Z, Sun J, Zhang J, Chen S, Wu Y, Li J, Zhong Y, , 2015. Clinical features of patients with Ebola virus disease in Sierra Leone. Clin Infect Dis 61: 491495.[Crossref] [Google Scholar]
  6. World Health Organization, 2015. Case Definition Recommendations for Ebola or Marburg Virus Diseases. Available at: http://www.who.int/csr/resources/publications/ebola/case-definition/en/. Accessed September 6, 2015. [Google Scholar]
  7. Brainard J, Hooper L, Pond K, Edmunds K, Hunter PR, , 2015. Risk factors for transmission of Ebola or Marburg virus disease: a systematic review and meta-analysis. Int J Epidemiol 45: 102116.[Crossref] [Google Scholar]
  8. Sullivan LM, Massaro JM, D'Agostino RB, , 2004. Presentation of multivariate data for clinical use: the Framingham Study risk score functions. Stat Med 23: 16311660.[Crossref] [Google Scholar]
  9. Zou KH, O'Malley AJ, Mauri L, , 2007. Receiver-operating characteristic analysis for evaluating diagnostic tests and predictive models. Circulation 115: 654657.[Crossref] [Google Scholar]
  10. Hsieh F, Turnbull BW, , 1996. Nonparametric and semiparametric estimation of the receiver operating characteristic curve. Ann Stat 24: 2540.[Crossref] [Google Scholar]
  11. Pittalis S, Fusco FM, Lanini S, Nisii C, Puro V, Lauria FN, Ippolito G, , 2009. Case definition for Ebola and Marburg haemorrhagic fevers: a complex challenge for epidemiologists and clinicians. New Microbiol 32: 359367. [Google Scholar]
  12. Dhillon RS, Srikrishna D, Sachs J, , 2014. Controlling Ebola: next steps. Lancet 384: 14091411.[Crossref] [Google Scholar]
  13. Maganga GD, Kapetshi J, Berthet N, Kebela Ilunga B, Kabange F, Mbala Kingebeni P, Mondonge V, Muyembe J-JT, Bertherat E, Briand S, Cabore J, Epelboin A, Formenty P, Kobinger G, González-Angulo L, Labouba I, Manuguerra J-C, Okwo-Bele J-M, Dye C, Leroy EM, , 2014. Ebola virus disease in the Democratic Republic of Congo. N Engl J Med 371: 20832091.[Crossref] [Google Scholar]
  14. Lado M, Walker NF, Baker P, Haroon S, Brown CS, Youkee D, Studd N, Kessete Q, Maini R, Boyles T, Hanciles E, Wurie A, Kamara TB, Johnson O, Leather AJM, , 2015. Clinical features of patients isolated for suspected Ebola virus disease at Connaught Hospital, Freetown, Sierra Leone: a retrospective cohort study. Lancet Infect Dis 15: 10241033.[Crossref] [Google Scholar]
  15. Levine AC, Shetty PP, Burbach R, Cheemalapati S, Glavis-Bloom J, Wiskel T, Kesselly JKT, , 2015. Derivation and internal validation of the Ebola prediction score for risk stratification of patients with suspected Ebola virus disease. Ann Emerg Med 66: 285293.[Crossref] [Google Scholar]
  16. Bah EI, Lamah M-C, Fletcher T, Jacob ST, Brett-Major DM, Sall AA, Shindo N, Fischer WA, Lamontagne F, Saliou SM, Bausch DG, Moumié B, Jagatic T, Sprecher A, Lawler JV, Mayet T, Jacquerioz FA, Méndez Baggi MF, Vallenas C, Clement C, Mardel S, Faye O, Faye O, Soropogui B, Magassouba N, Koivogui L, Pinto R, Fowler RA, , 2015. Clinical presentation of patients with Ebola virus disease in Conakry, Guinea. N Engl J Med 372: 4047.[Crossref] [Google Scholar]
  17. Schieffelin JS, Shaffer JG, Goba A, Gbakie M, Gire SK, Colubri A, Sealfon RSG, Kanneh L, Moigboi A, Momoh M, Fullah M, Moses LM, Brown BL, Andersen KG, Winnicki S, Schaffner SF, Park DJ, Yozwiak NL, Jiang P-P, Kargbo D, Jalloh S, Fonnie M, Sinnah V, French I, Kovoma A, Kamara FK, Tucker V, Konuwa E, Sellu J, Mustapha I, Foday M, Yillah M, Kanneh F, Saffa S, Massally JLB, Boisen ML, Branco LM, Vandi MA, Grant DS, Happi C, Gevao SM, Fletcher TE, Fowler RA, Bausch DG, Sabeti PC, Khan SH, Garry RF, , 2014. Clinical illness and outcomes in patients with Ebola in Sierra Leone. N Engl J Med 371: 20922100.[Crossref] [Google Scholar]
  18. Yan T, Mu J, Qin E, Wang Y, Liu L, Wu D, Jia H, Li Z, Guo T, Wang X, Qin Y, Li Y, Chen S, Zhang Y, Zhang J, Wu Y, Wang S, Li J, , 2015. Clinical characteristics of 154 patients suspected of having Ebola virus disease in the Ebola holding center of Jui Government Hospital in Sierra Leone during the 2014 Ebola outbreak. Eur J Clin Microbiol Infect Dis 34: 20892095.[Crossref] [Google Scholar]

Data & Media loading...

  • Received : 09 Jan 2016
  • Accepted : 08 Jul 2016
  • Published online : 07 Dec 2016

Most Cited This Month

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error