Doctors Without Borders / Médecins Sans Frontières, Brussels, Belgium.
Euro Surveill. 2015;20(50). doi: 10.2807/1560-7917.ES.2015.20.50.30097.
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.
预防埃博拉病毒（EBOV）在埃博拉管理中心（EMC）住院患者中的感染至关重要。目前，无国界医生组织（MSF）的指南建议将分诊入院的患者分为疑似和高度疑似类别，等待实验室确认。我们调查了 MSF 分诊系统的性能，以将随后实验室检测呈 EBOV 阳性的患者（真阳性入院）与最初因临床原因入院但随后 EBOV 检测阴性的患者（假阳性入院）区分开来。我们在 2014 年 7 月 1 日至 9 月 30 日期间，对塞拉利昂凯拉洪的 MSF EMC 收治的 433 名患者进行了研究，计算了分诊分配到疑似或高度疑似病房（指标试验）以及随后的阳性或阴性实验室结果（参考试验）的标准诊断测试统计数据。254 例（59%）入院被归类为高度疑似，其余 179 例（41%）为疑似。276 例（64%）为真阳性入院，其余 157 例（36.3%）为假阳性入院，有感染埃博拉病毒的风险。被分配到高度疑似病房后获得阳性实验室结果的阳性预测值为 76%。相应的阴性预测值为 54%。敏感性和特异性分别为 70%和 61%。患者分类准确的结果并不令人信服。目前的分诊系统应进行更改。只要有可能，应在等待实验室确认的情况下将患者安置在单人病房中。此外，必须改进是否首先收治患者的初始分诊步骤。最终需要的是一种可靠、准确、稳健、移动、负担得起、易于在严格的生物安全协议之外使用、提供快速周转时间结果的即时护理 EBOV 诊断测试。
