Children died rapidly, more than half in Ebola holding units before transfer to treatment units.

We compared children who were positive for Ebola virus disease (EVD) with those who were negative to derive a pediatric EVD predictor (PEP) score. We collected data on all children <13 years of age admitted to 11 Ebola holding units in Sierra Leone during August 2014–March 2015 and performed multivariable logistic regression. Among 1,054 children, 309 (29%) were EVD positive and 697 (66%) EVD negative, with 48 (5%) missing. Contact history, conjunctivitis, and age were the strongest positive predictors for EVD. The PEP score had an area under receiver operating characteristics curve of 0.80. A PEP score of 7/10 was 92% specific and 44% sensitive; 3/10 was 30% specific, 94% sensitive. The PEP score could correctly classify 79%–90% of children and could be used to facilitate triage into risk categories, depending on the sensitivity or specificity required.

Health professions education in the 21st century should incorporate both community mobilization and social media strategies. First, community mobilization facilitates change by educating community members with evidence-based, high-quality and up-to-date health information and empowering their active participation in target health initiatives. Second, advancements in technology and globalization foster the development of innovative communication technologies used as a key tool in the ‘roll out’ of community health initiatives during epidemics such as Ebola virus disease. In August 2014, medical students of Sierra Leone and Guinea used these dual health promotional strategies in the Kick Ebola Out campaign to educate community members about transmission of the Ebola virus and preventive measures, as well as to reduce perceptions related to stigma or fear of disease transmission. In this report, we describe how medical students, who are trained in basic and clinical sciences, evidence-based practices, and social determinants of health, can serve as human resources for health and facilitate dynamic communication strategies to educate and empower both medical students and community members for local or national health initiatives.

Background The case defi nition for suspected Ebola virus disease is broad, so many negative children are isolated for testing, risking nosocomial infection. We collected data on children admitted to Ebola holding units in Sierra Leone to refi ne the case defi nition and describe outcomes of admitted children. MethodsAll children aged less than 13 years admitted to 11 Ebola holding units in Sierra Leone between Aug 1, 2014, and March 31, 2015, were eligible for inclusion. Data were collected from paper-based clinical records, district-wide laboratory results, burial records, staff interviews, and follow-up telephone calls. The cohort was split into training and validation datasets. A model was developed with multivariable logistic regression and compared with laboratory results to explore the sensitivity and specifi city of the alternative case defi nition. Findings Of 1054 children admitted, 309 (29%) tested positive for Ebola virus disease and 697 (66%) tested negative (48 [5%] missing). The model had an area under receiver operating characteristic curve of 0•80 (high performance).A case defi nition of Ebola virus disease contact alone, fever (in children >2 years), or fever and conjunctivitis (<2 years) was 94% sensitive and 35% specifi c. Contact, fever, and conjunctivitis, or contact, fever, anorexia, and two of abdominal pain, diarrhoea, or male sex (>2 years) improved specifi city (97%), with sensitivity of 23%. Children testing negative had a case fatality rate of 8% versus 57% in those with Ebola virus disease (p<0•001).Interpretation Contact history, fever, conjunctivitis, abdominal pain, and diarrhoea are key characteristics for diagnosis of paediatric Ebola virus disease. The case defi nitions developed can be used fl exibly-for example, for triage into risk categories to reduce risk of nosocomial infection.

Background Extending the time to definitive hemorrhage control in non-compressible torso hemorrhage (NCTH) is of particular importance in the battlefield where transfer times are prolonged and NCTH remains the leading cause of death. While REBOA is widely practiced as an initial adjunct for the management of NCTH, concerns for ischemic complications after 30 minutes of compete aortic occlusion deters many from Zone 1 deployment. We hypothesize that extended zone 1 occlusion times will be enabled by novel purpose built devices that allow for titratable partial aortic occlusion. Methods This is a cross sectional analysis describing pREBOA-PRO zone 1 deployment characteristics at 7 level-1 trauma centers in the US and Canada (March 30, 2021 and June 30, 2022). In order to compare patterns of zone 1 aortic occlusion, the AORTA registry was utilized. Data was limited to adult patients who underwent successful occlusion in zone 1 (2013-2022). Results One hundred twenty-two patients pREBOA-PRO patients were included. Most catheters were deployed in zone 1 (73% n = 89) with a median zone 1 total occlusion time of 40 minutes (IQR 25-74). A sequence of complete followed by partial occlusion was used in 42% (n = 37) of zone 1 occlusion patients; a median of 76% (IQR 60-87%) of total occlusion time was partial occlusion in this group. As was seen in the prospectively collected data, longer median total occlusion times were observed in the titratable occlusion group in AORTA compared to the complete occlusion group. Conclusions Longer zone 1 aortic occlusion times seen with titratable aortic occlusion catheters appear to be driven by the feasibility of controlled partial occlusion. The ability to extend safe aortic occlusion times may have significant impact to combat casualty care where exsanguination from non-compressible torso hemorrhage is the leading source of potentially preventable deaths. Level of evidence Level IV evidence