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Citation Information

Type Journal Article - Eurosurveillance
Title Assessment of the MSF triage system, separating patients into different wards pending Ebola virus laboratory confirmation, Kailahun, Sierra Leone, July to September 2014
Author(s)
Volume 20
Issue 50
Publication (Day/Month/Year) 2015
URL http://fieldresearch.msf.org/msf/bitstream/10144/600283/1/Vogt et al - 2015 - Assessment of the MSF​triage system.pdf
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 highlysuspect
categories pending laboratory confirmation.
We investigated the performance of the MSF triage
system to separate patients with subsequent EBOVpositive
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.

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