Assessment of the MSF Triage System, Separating Patients into Different Wards Pending Ebola Virus Laboratory Confirmation, Kailahun, Sierra Leone, July to September 2014

Hdl Handle:
http://hdl.handle.net/10144/600283
Title:
Assessment of the MSF Triage System, Separating Patients into Different Wards Pending Ebola Virus Laboratory Confirmation, Kailahun, Sierra Leone, July to September 2014
Authors:
Vogt, F; Fitzpatrick, G; Patten, G; van den Bergh, R; Stinson, K; Pandolfi, L; Squire, J; Decroo, T; Declerck, H; Van Herp, M
Journal:
Eurosurveillance
Abstract:
Prevention of nosocomial Ebola virus (EBOV) infection among patients admitted to an Ebola management centre (EMC) is paramount. Current Médecins Sans Frontières (MSF) guidelines recommend classifying admitted patients at triage into suspect and highly-suspect categories pending laboratory confirmation. We investigated the performance of the MSF triage system to separate patients with subsequent EBOV-positive laboratory test (true-positive admissions) from patients who were initially admitted on clinical grounds but subsequently tested EBOV-negative (false-positive admissions). We calculated standard diagnostic test statistics for triage allocation into suspect or highly-suspect wards (index test) and subsequent positive or negative laboratory results (reference test) among 433 patients admitted into the MSF EMC Kailahun, Sierra Leone, between 1 July and 30 September 2014. 254 (59%) of admissions were classified as highly-suspect, the remaining 179 (41%) as suspect. 276 (64%) were true-positive admissions, leaving 157 (36.3%) false-positive admissions exposed to the risk of nosocomial EBOV infection. The positive predictive value for receiving a positive laboratory result after being allocated to the highly-suspect ward was 76%. The corresponding negative predictive value was 54%. Sensitivity and specificity were 70% and 61%, respectively. Results for accurate patient classification were unconvincing. The current triage system should be changed. Whenever possible, patients should be accommodated in single compartments pending laboratory confirmation. Furthermore, the initial triage step on whether or not to admit a patient in the first place must be improved. What is ultimately needed is a point-of-care EBOV diagnostic test that is reliable, accurate, robust, mobile, affordable, easy to use outside strict biosafety protocols, providing results with quick turnaround time.
Publisher:
European Centre for Disease Prevention and Control
Issue Date:
17-Dec-2015
URI:
http://hdl.handle.net/10144/600283
DOI:
10.2807/1560-7917.ES.2015.20.50.30097
PubMed ID:
26727011
Type:
Article
Language:
en
ISSN:
1560-7917
Appears in Collections:
Other Diseases

Full metadata record

DC FieldValue Language
dc.contributor.authorVogt, Fen
dc.contributor.authorFitzpatrick, Gen
dc.contributor.authorPatten, Gen
dc.contributor.authorvan den Bergh, Ren
dc.contributor.authorStinson, Ken
dc.contributor.authorPandolfi, Len
dc.contributor.authorSquire, Jen
dc.contributor.authorDecroo, Ten
dc.contributor.authorDeclerck, Hen
dc.contributor.authorVan Herp, Men
dc.date.accessioned2016-02-28T13:49:54Zen
dc.date.available2016-02-28T13:49:54Zen
dc.date.issued2015-12-17en
dc.identifier.citationAssessment of the MSF triage system, separating patients into different wards pending Ebola virus laboratory confirmation, Kailahun, Sierra Leone, July to September 2014. 2015, 20 (50): Euro Surveill.en
dc.identifier.issn1560-7917en
dc.identifier.pmid26727011en
dc.identifier.doi10.2807/1560-7917.ES.2015.20.50.30097en
dc.identifier.urihttp://hdl.handle.net/10144/600283en
dc.description.abstractPrevention of nosocomial Ebola virus (EBOV) infection among patients admitted to an Ebola management centre (EMC) is paramount. Current Médecins Sans Frontières (MSF) guidelines recommend classifying admitted patients at triage into suspect and highly-suspect categories pending laboratory confirmation. We investigated the performance of the MSF triage system to separate patients with subsequent EBOV-positive laboratory test (true-positive admissions) from patients who were initially admitted on clinical grounds but subsequently tested EBOV-negative (false-positive admissions). We calculated standard diagnostic test statistics for triage allocation into suspect or highly-suspect wards (index test) and subsequent positive or negative laboratory results (reference test) among 433 patients admitted into the MSF EMC Kailahun, Sierra Leone, between 1 July and 30 September 2014. 254 (59%) of admissions were classified as highly-suspect, the remaining 179 (41%) as suspect. 276 (64%) were true-positive admissions, leaving 157 (36.3%) false-positive admissions exposed to the risk of nosocomial EBOV infection. The positive predictive value for receiving a positive laboratory result after being allocated to the highly-suspect ward was 76%. The corresponding negative predictive value was 54%. Sensitivity and specificity were 70% and 61%, respectively. Results for accurate patient classification were unconvincing. The current triage system should be changed. Whenever possible, patients should be accommodated in single compartments pending laboratory confirmation. Furthermore, the initial triage step on whether or not to admit a patient in the first place must be improved. What is ultimately needed is a point-of-care EBOV diagnostic test that is reliable, accurate, robust, mobile, affordable, easy to use outside strict biosafety protocols, providing results with quick turnaround time.en
dc.language.isoenen
dc.publisherEuropean Centre for Disease Prevention and Controlen
dc.rightsArchived with thanks to Euro surveillance : bulletin Européen sur les maladies transmissibles = European communicable disease bulletinen
dc.titleAssessment of the MSF Triage System, Separating Patients into Different Wards Pending Ebola Virus Laboratory Confirmation, Kailahun, Sierra Leone, July to September 2014en
dc.typeArticleen
dc.identifier.journalEurosurveillanceen

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