Development of a Pediatric Ebola Predictive Score, Sierra Leone1

Abstract

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.

Clinical and epidemiological performance of WHO Ebola case definitions: a systematic review and meta-analysis

“…One study assessed WHO 2014 case definitions for a paediatric population (younger than 13 years old); the sensitivity was 98•0% (95% CI 95•0-99•0) and specificity was 5•0% (3•0-7•0). 25 When WHO subdefinitions were assessed, history of contact and symptoms had high specificity compared with clinical symptoms alone, ranging from 62•3% (95% CI 49•8-73•5) to 94•4% (95% CI not provided in original paper; table 2). The highest sensitivity (100•0%) was documented for the WHO subdefinitions in which fever was not mandatory.…”

“…One was excluded because it is yet unpublished (FG). Of the 14 included studies, 11 were full manuscripts, 5,6,22,24,25,27,[29][30][31][32][33] one a letter, 28 one an oral plenary abstract, 26 and one a conference poster 23 (the author of this poster was also contacted and they provided an abstract with additional data [ (seven in Sierra Leone, 5,6,25,26,30,32,33 four in Guinea, 24,27,28,31 and two in Liberia 23,29 ). The remaining article was published in May, 2010, assessing Marburg virus in Angola.…”

“…24,27 All selected manuscripts analysed all ages combined, except one author who assessed, in two different studies, the sensitivity and specificity of 2014 WHO Ebola case definitions and also developed a risk score specifically for the paediatric population (younger than 13 years). 25,26 Six studies explored the performance of a WHO case definition in non-paediatric populations. 5,22,24,[29][30][31] In all of these studies, suspected and probable cases were combined and could not be disaggregated for analysis.…”

Ebola Virus Disease in the Obstetric Population

“…A sensitive and specific clinical case definition for EVD in children would allow rapid access to appropriate treatment for children with EVD, crucial when early mortality is so high, and also protect children without EVD (with a different illness) from exposure to EVD while awaiting laboratory test confirmation. To date there has been only one attempt at deriving a paediatric-specific case definition using multicentre data on over 1000 children from the West African outbreak, and this case definition has not yet been validated on wider datasets [ 106 ]. It also does not include malaria rapid diagnostic test results which have been shown to be an important discriminator in a mixed age study [ 107 ].…”

Prediction of disease severity in young children presenting with acute febrile illness in resource-limited settings: a protocol for a prospective observational study

“…19 A recent systematic review concluded that the validity of existing paediatric triage tools is uncertain and that none are likely to be reliable in resource-constrained environments, with the lack of follow-up data for children not admitted highlighted as a major limitation of current research in this field. 20 While some disease-specific tools have been developed, [21][22][23] their application is limited as it is often only possible to ascertain a microbiological cause in a minority of febrile children.…”