Abstract
Rapidly identifying likely Ebola patients is difficult because of a broad case definition, overlap of symptoms with common illnesses, and lack of rapid diagnostics. However, rapid identification is critical for care and containment of contagion. We analyzed retrospective data from 252 Ebola-positive and 172 Ebola-negative patients at a Sierra Leone Ebola treatment center to develop easy-to-use risk scores, based on symptoms and laboratory tests (if available), to stratify triaged patients by their likelihood of having Ebola infection. Headache, diarrhea, difficulty breathing, nausea/vomiting, loss of appetite, and conjunctivitis comprised the symptom-based score. The laboratory-based score also included creatinine, creatine kinase, alanine aminotransferase, and total bilirubin. This risk score correctly identified 92% of Ebola-positive patients as high risk for infection; both scores correctly classified >70% of Ebola-negative patients as low or medium risk. Clinicians can use these risk scores to gauge the likelihood of triaged patients having Ebola while awaiting laboratory confirmation.
Highlights
Identifying likely Ebola patients is difficult because of a broad case definition, overlap of symptoms with common illnesses, and lack of rapid diagnostics
Ebola virus disease (EVD) can be difficult to initially identify even in a well-functioning health system because its early symptoms can closely mimic those of other common illnesses, such as malaria, typhoid, viral illness, and gastroenteritis [2,3]
We evaluated the score by calculating the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for each level by designating all patients below that level as EVD negative and those at or above it as EVD positive
Summary
Identifying likely Ebola patients is difficult because of a broad case definition, overlap of symptoms with common illnesses, and lack of rapid diagnostics. Patients meeting the case definition, which is based on symptoms and potential exposure, were sent to holding centers for EVD testing and isolation. Symptom- and Laboratory-Based Ebola Risk Scores resource-limited settings because a range of persons, from community health workers to clinicians, can quickly obtain the necessary patient information [9,10].
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