title: Derivation and Internal Validation of the Ebola Prediction Score for Risk Stratification of Patients With Suspected Ebola Virus Disease.
abstract: OBJECTIVE
  The current outbreak of Ebola virus disease in West Africa is the largest on record and has overwhelmed the capacity of local health systems and the international community to provide sufficient isolation and treatment of all suspected cases. The goal of this study is to develop a clinical prediction model that can help clinicians risk-stratify patients with suspected Ebola virus disease in the context of such an epidemic.
  
  
  METHODS
  A retrospective analysis was performed of patient data collected during routine clinical care at the Bong County Ebola Treatment Unit in Liberia during its first 16 weeks of operation. The predictive power of 14 clinical and epidemiologic variables was measured against the primary outcome of laboratory-confirmed Ebola virus disease, using logistic regression to develop a final prediction model. Bootstrap sampling was used to assess the internal validity of the model and estimate its performance in a simulated validation cohort.
  
  
  RESULTS
  Ebola virus disease testing results were available for 382 (97%) of 395 patients admitted to the Ebola treatment unit during the study period. A total of 160 patients (42%) tested positive for Ebola virus disease. Logistic regression analysis identified 6 variables independently predictive of laboratory-confirmed Ebola virus disease, including sick contact, diarrhea, loss of appetite, muscle pains, difficulty swallowing, and absence of abdominal pain. The Ebola Prediction Score, constructed with these 6 variables, had an area under the receiver operator characteristic curve of 0.75 (95% confidence interval 0.70 to 0.80) for the prediction of laboratory-confirmed Ebola virus disease. Patients with higher Ebola Prediction Scores had higher likelihoods of laboratory-confirmed Ebola virus disease.
  
  
  CONCLUSIONS
  The Ebola Prediction Score can be used by clinicians as an adjunct to current Ebola virus disease case definitions to risk-stratify patients with suspected Ebola virus disease. Clinicians can use this new tool for the purpose of cohorting patients within the suspected-disease ward of an Ebola treatment unit or community-based isolation center to prevent nosocomial infection or as a triage tool when patient numbers overwhelm available capacity. Given the inherent limitations of clinical prediction models, however, a low-cost, point-of-care test that can rapidly and definitively exclude Ebola virus disease in patients should be a research priority.
authors.affiliation: Warren Alpert School of Medicine, Brown University, Providence, RI. Electronic address: adam_levine@brown.edu.
authors.forename: Adam C
authors.initials: AC
authors.lastname: Levine
authors.affiliation: International Medical Corps, Los Angeles, CA.
authors.forename: Pranav Prathap
authors.initials: PP
authors.lastname: Shetty
authors.affiliation: International Medical Corps, Los Angeles, CA.
authors.forename: Ryan
authors.initials: R
authors.lastname: Burbach
authors.affiliation: International Medical Corps, Los Angeles, CA.
authors.forename: Sambhavi
authors.initials: S
authors.lastname: Cheemalapati
authors.affiliation: Warren Alpert School of Medicine, Brown University, Providence, RI.
authors.forename: Justin
authors.initials: J
authors.lastname: Glavis-Bloom
authors.affiliation: Warren Alpert School of Medicine, Brown University, Providence, RI.
authors.forename: Tess
authors.initials: T
authors.lastname: Wiskel
authors.affiliation: College of Allied Health Sciences, Cuttington University, Suakoko, Liberia.
authors.forename: J Kota T
authors.initials: JK
authors.lastname: Kesselly
mesh_terms: D015746:Abdominal Pain / Q000209:etiology; D000293:Adolescent; D000328:Adult; D001066:Appetite; D002648:Child; D002675:Child, Preschool; D003661:Decision Support Techniques; D003680:Deglutition Disorders / Q000209:etiology; D003967:Diarrhea / Q000209:etiology; D004196:Disease Outbreaks; D005260:Female; D019142:Hemorrhagic Fever, Ebola / Q000150:complications / Q000175:diagnosis*; D006801:Humans; D007988:Liberia / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D063806:Myalgia / Q000209:etiology; D012372:ROC Curve; D015203:Reproducibility of Results; D012189:Retrospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D055815:Young Adult