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Volume 24, Number 2—February 2018
Research

Development of a Pediatric Ebola Predictive Score, Sierra Leone1

Felicity Fitzgerald2Comments to Author , Kevin Wing2, Asad Naveed, Musa Gbessay, J.C.G. Ross, Francesco Checchi, Daniel Youkee, Mohamed Boie Jalloh, David E. Baion, Ayeshatu Mustapha, Hawanatu Jah, Sandra Lako, Shefali Oza, Sabah Boufkhed, Reynold Feury, Julia Bielicki, Elizabeth Williamson, Diana M. Gibb, Nigel Klein, Foday Sahr, and Shunmay Yeung
Author affiliations: University College London Great Ormond Street Institute of Child Health, London, UK (F. Fitzgerald, N. Klein); Save the Children, Freetown, Sierra Leone, and London (F. Fitzgerald, K. Wing, A. Naveed, M. Gbessay, J.C.G. Ross, F. Checchi); London School of Hygiene & Tropical Medicine, London (K. Wing, F. Checchi, S. Oza, S. Boufkhed, E. Williamson, S. Yeung); Kings Sierra Leone Partnership, Kings Centre for Global Health, Kings College London, London (D. Youkee); 34 Military Hospital, Republic of Sierra Leone Armed Forces, Freetown (M.B. Jalloh, F. Sahr); Ola During Children’s Hospital, Sierra Leone Ministry of Health, Freetown (D.E. Baion, A. Mustapha); Cap Anamur (German Emergency Doctors), Ola During Children’s Hospital, Freetown (H. Jah); Welbodi Partnership, Ola During Children’s Hospital, Freetown (S. Lako); Western Area Emergency Response Centre, Freetown (R. Feury); MRC Clinical Trials Unit at UCL, London (J. Bielicki, D.M. Gibb); Farr Institute of Health Informatics, London (E. Williamson)

Main Article

Table 1

Overview of 1,006 children who attended an Ebola holding unit and had EVD test results recorded, by final EVD test result status, Sierra Leone, August 14, 2014–March 31, 2015*

Characteristic
All children, 
no. (%) or median (IQR)
 EVD negative
EVD positive p value
No./no. available or median (IQR)
 % (95% CI)
 No./no. available or median (IQR)
 % (95% CI)
Total†
 1,006 (100)
 697
 69
309
 31
 –
Sex
F 512 (51) 348/697 50 (46–54) 164/309 47 (41–53) 0.357
M
 494 (49)
 349/697
 50 (46-54)
145/309
 53 (47–59)
 0.380
Median age, y (IQR) 4 (1.3–8) 3 (1–7) – 6 (3–10) – <0.001
Age 0–2 y 392 (39) 336/697 48 (44–52) 56/309 18 (14–23) <0.001
Positive contact, n = 754‡
 275 (36)
 108/541
 20 (17–24)
167/213
 78 (72–84)
 <0.001
Days from symptoms to EHU admission, n = 772 2 (1–4) 2 (1–3) – 3 (2–4) – 0.001
Admitted with caregiver, n = 822
 822 (82)
 516/621
 83 (80–86)
127/201
 63 (56–70)
 <0.001
Signs/symptoms§
Fever, n = 787 740 (94) 528/566 93 (91–95) 212/221 96 (92–98) 0.160
Fatigue/weakness, n = 587 568 (97) 393/407 97 (94–98) 175/180 97 (94–99) 0.676
Vomiting/nausea, n = 777 472 (61) 345/556 62 (58–66) 127/221 57 (51–64) 0.238
Diarrhea, n = 763 351 (46) 252/548 46 (42–50) 99/215 46 (39–53) 0.988
Conjunctivitis, n = 669 152 (23) 73/463 16 (13–19) 79/206 38 (32–45) <0.001
Anorexia, n = 779 621 (80) 452/560 81 (77–84) 169/219 77 (71–83) 0.269
Abdominal pain, n = 594 269 (45) 155/392 40 (35–45) 114/202 56 (49–63) <0.001
Muscle pain, n = 577 212 (21) 127/377 34 (29–39) 85/200 43 (36–50) 0.037
Joint pain, n = 569 192 (34) 102/368 28 (23–33) 90/201 45 (38–52) <0.001
Headache, n = 598 370 (62) 256/397 65 (60–69) 114/201 57 (50–64) 0.065
Difficulty breathing, n = 738 199 (27) 169/533 32 (28–36) 30/205 15 (10–20) <0.001
Difficulty swallowing, n = 687 177 (26) 130/481 27 (23–31) 47/206 23 (17–29) 0.247
Rash, n = 728 98 (13) 88/522 17 (14–20) 10/206 5 (2–9) <0.001
Cough, n = 587 70 (12) 57/407 14 (11–18) 13/180 7 (4–12) 0.019
Hiccups, n = 723 62 (9) 52/519 10 (8–13) 10/204 5 (2–9) 0.027
Unexplained bleeding, n = 726
 22 (3)
 19/518
 4 (2–6)
3/208
 1 (0–4)
 0.114
Treatment¶
Antimicrobial drug, n = 657 556 (85) 407/494 82 (79–86) 149/163 91 (86–95) 0.006
Antimalarial drug, n = 657 567 (86) 416/494 84 (81–87) 151/163 93 (87–96) 0.007
IV treatment
 115 (11)
 101/697
 14 (12–17)
14/309
 5 (2–7)
 <0.001
Malaria RDT+, n = 74 33 (45) 31/57 54 (41–68) 2/17 12 (15–36) 0.002
Median days of EHU stay# 2 (1–3) 2 (1–2) – 2 (1–3) – <0.001

*n values and denominators indicate no. children with recorded data available for variable (i.e., for binary variables children with neither “yes” nor “no” populated in their source notes were not included in the denominator, and for the median days symptoms to EHU admission variable those without date of start of symptoms were not included). EHU, Ebola holding unit; EVD, Ebola virus disease; RDT, rapid diagnostic test.
†z-test of proportions, comparing whether the proportion of children with the variable was the same for EVD-negative and EVD-positive children (apart from numerical variables, for which a Wilcoxon rank-sum test was performed to test the hypothesis that the distribution of the variable was the same for EVD-negative and EVD-positive children).
‡Total no. children admitted to holding units with test results available.
§Recorded on presentation at EHU.
¶At EHU.
#Time from EHU admission until death, discharge, or transfer.

Main Article

1Preliminary results from this study were presented at the 26th European Congress of Clinical Microbiology and Infectious Diseases, Amsterdam, Netherlands, April 9–12, 2016; and the 34th Annual Meeting of the European Society for Pediatric Infectious Diseases, Brighton, UK, May 10–14, 2016.

2These authors contributed equally to this article.

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Page updated: January 17, 2018
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