World Health Organization, 2015. Ebola Situation Reports. Available at: http://apps.who.int/ebola/ebola-situation-reports. Accessed September 6, 2015.
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): S761–S767.
Kortepeter MG, Bausch DG, Bray M, 2011. Basic clinical and laboratory features of filoviral hemorrhagic fever. J Infect Dis 204 (Suppl 3): S810–S816.
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: 1821–1824.
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: 491–495.
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.
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: 102–116.
Sullivan LM, Massaro JM, D'Agostino RB, 2004. Presentation of multivariate data for clinical use: the Framingham Study risk score functions. Stat Med 23: 1631–1660.
Zou KH, O'Malley AJ, Mauri L, 2007. Receiver-operating characteristic analysis for evaluating diagnostic tests and predictive models. Circulation 115: 654–657.
Hsieh F, Turnbull BW, 1996. Nonparametric and semiparametric estimation of the receiver operating characteristic curve. Ann Stat 24: 25–40.
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: 359–367.
Dhillon RS, Srikrishna D, Sachs J, 2014. Controlling Ebola: next steps. Lancet 384: 1409–1411.
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: 2083–2091.
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: 1024–1033.
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: 285–293.
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: 40–47.
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: 2092–2100.
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: 2089–2095.
|Past two years||Past Year||Past 30 Days|
|Full Text Views||397||166||2|
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.
Financial support: The Alima ETC project was funded by ECHO (European Commission Humanitarian Office), BMGF (Bill & Melinda Gates Foundation), Avaaz, and OSIWA.
Authors' addresses: Paul Loubet and Yazdan Yazdanpanah, Infectious Diseases Ward, Assistance Publique–Hôpitaux de Paris (AP-HP), Hopital Bichat-Claude Bernard, Paris, France, E-mails: email@example.com and firstname.lastname@example.org. Romain Palich, Richard Kojan, Olivier Peyrouset, Mamadou Conde, and Augustin Augier, Alliance for International Medical Action (ALIMA), Paris, France, E-mails: email@example.com, firstname.lastname@example.org, email@example.com, firstname.lastname@example.org, and email@example.com. Christine Danel, Program PACCI, ANRS, Abidjan, Côte d'Ivoire, E-mail: firstname.lastname@example.org. Sarala Nicholas and Klaudia Porten, Epicentre, Mèdecins Sans Frontières, Paris, France, E-mails: email@example.com and firstname.lastname@example.org.