{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T20:20:22Z","timestamp":1788898822882,"version":"build-2803163510"},"reference-count":37,"publisher":"Public Library of Science (PLoS)","issue":"12","license":[{"start":{"date-parts":[[2022,12,16]],"date-time":"2022-12-16T00:00:00Z","timestamp":1671148800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"US National Health Institute","award":["NIH FIC\/R01EY031894"],"award-info":[{"award-number":["NIH FIC\/R01EY031894"]}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>The control of Ebola virus disease (EVD) outbreaks relies on rapid diagnosis and prompt action, a daunting task in limited-resource contexts.<\/jats:p>\n<jats:p>This study develops prediction scores that can help healthcare workers improve their decision-making at the triage-point of EVD suspect-cases during EVD outbreaks.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>We computed accuracy measurements of EVD predictors to assess their diagnosing ability compared with the reference standard GeneXpert\u00ae results, during the eastern DRC EVD outbreak. We developed predictive scores using the Spiegelhalter-Knill-Jones approach and constructed a clinical prediction score (CPS) and an extended clinical prediction score (ECPS). We plotted the receiver operating characteristic curves (ROCs), estimated the area under the ROC (AUROC) to assess the performance of scores, and computed net benefits (NB) to assess the clinical utility (decision-making ability) of the scores at a given cut-off. We performed decision curve analysis (DCA) to compare, at a range of threshold probabilities, prediction scores\u2019 decision-making ability and to quantify the number of unnecessary isolation.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>The analysis was done on data from 10432 subjects, including 651 EVD cases. The EVD prevalence was 6.2% in the whole dataset, 14.8% in the subgroup of suspects who fitted the WHO Ebola case definition, and 3.2% for the set of suspects who did not fit this case definition. The WHO clinical definition yielded 61.6% sensitivity and 76.4% specificity. Fatigue, difficulty in swallowing, red eyes, gingival bleeding, hematemesis, confusion, hemoptysis, and a history of contact with an EVD case were predictors of EVD. The AUROC for ECPS was 0.88 (95%CI: 0.86\u20130.89), significantly greater than this for CPS, 0.71 (95%CI: 0.69\u20130.73) (p &lt; 0.0001). At -1 point of score, the CPS yielded a sensitivity of 85.4% and specificity of 42.3%, and the ECPS yielded sensitivity of 78.8% and specificity of 81.4%. The diagnostic performance of the scores varied in the three disease contexts (the whole, fitting or not fitting the WHO case definition data sets). At 10% of threshold probability, e.g. in disease-adverse context, ECPS gave an NB of 0.033 and a net reduction of unnecessary isolation of 67.1%. Using ECPS as a joint approach to isolate EVD suspects reduces the number of unnecessary isolations by 65.7%.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>The scores developed in our study showed a good performance as EVD case predictors since their use improved the net benefit, i.e., their clinical utility. These rapid and low-cost tools can help in decision-making to isolate EVD-suspicious cases at the triage point during an outbreak. However, these tools still require external validation and cost-effectiveness evaluation before being used on a large scale.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0278678","type":"journal-article","created":{"date-parts":[[2022,12,16]],"date-time":"2022-12-16T18:25:45Z","timestamp":1671215145000},"page":"e0278678","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":7,"title":["Development of Ebola virus disease prediction scores: Screening tools for Ebola suspects at the triage-point during an outbreak"],"prefix":"10.1371","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2440-8468","authenticated-orcid":true,"given":"Antoine Oloma","family":"Tshomba","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel-Ricky","family":"Mukadi-Bamuleka","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9377-4766","authenticated-orcid":true,"given":"Anja","family":"De Weggheleire","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olivier M.","family":"Tshiani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard O.","family":"Kitenge","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charles T.","family":"Kayembe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bart K. M.","family":"Jacobs","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7183-4895","authenticated-orcid":true,"given":"Lutgarde","family":"Lynen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Placide","family":"Mbala-Kingebeni","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean-Jacques","family":"Muyembe-Tamfum","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steve","family":"Ahuka-Mundeke","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5886-2004","authenticated-orcid":true,"given":"Dieudonn\u00e9 N.","family":"Mumba","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D\u00e9sir\u00e9 D.","family":"Tshala-Katumbay","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sabue","family":"Mulangu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2022,12,16]]},"reference":[{"key":"pone.0278678.ref001","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1016\/j.virol.2013.04.014","article-title":"Genomic analysis of filoviruses associated with four viral hemorrhagic fever outbreaks in Uganda and the Democratic Republic of the Congo in 2012","volume":"442","author":"CG Albari\u00f1o","year":"2013","journal-title":"Virology"},{"key":"pone.0278678.ref002","doi-asserted-by":"crossref","first-page":"20160297","DOI":"10.1098\/rstb.2016.0297","article-title":"The Ebola outbreak, 2013\u20132016: old lessons for new epidemics","volume":"372","author":"CE Coltart","year":"2017","journal-title":"Philos Trans R Soc Lond B Biol Sci"},{"issue":"Suppl 1","key":"pone.0278678.ref003","doi-asserted-by":"crossref","first-page":"S65","DOI":"10.1086\/514290","article-title":"Ebola hemorrhagic fever outbreaks in Gabon, 1994\u20131997: epidemiologic and health control issues.","volume":"179","author":"AJ Georges","year":"1999","journal-title":"J Infect Dis"},{"key":"pone.0278678.ref004","doi-asserted-by":"crossref","first-page":"e09015","DOI":"10.7554\/eLife.09015","article-title":"Ebola virus disease in the Democratic Republic of the Congo, 1976\u20132014","volume":"4","author":"A Rosello","year":"2015","journal-title":"Elife"},{"key":"pone.0278678.ref005","doi-asserted-by":"crossref","first-page":"1162","DOI":"10.15585\/mmwr.mm6850a3","article-title":"Ebola Virus Disease Outbreak\u2014Democratic Republic of the Congo, August 2018-November 2019.","volume":"68","author":"Aaron Aruna","year":"2019","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"pone.0278678.ref006","doi-asserted-by":"crossref","first-page":"587","DOI":"10.1056\/NEJMsr1513109","article-title":"After Ebola in West Africa\u2014Unpredictable Risks, Preventable Epidemics.","volume":"375","author":"WHO Ebola Response Team.","year":"2016","journal-title":"N Engl J Med"},{"key":"pone.0278678.ref007","unstructured":"The World Bank. 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