Influence of referral pathway on ebola virus disease case-fatality rate and effect of survival selection bias

Frauke Rudolf; Mads Damkjær; Suzanne Lunding; Kenn Dornonville de la Cour; Alyssa Young; Tim Brooks; Tom Sesay; Alex P. Salam; Sharmistha Mishra; Merete Storgaard

doi:10.3201/eid2304.160485

Influence of referral pathway on ebola virus disease case-fatality rate and effect of survival selection bias

Frauke Rudolf^*, Mads Damkjær, Suzanne Lunding, Kenn Dornonville de la Cour, Alyssa Young, Tim Brooks, Tom Sesay, Alex P. Salam, Sharmistha Mishra, Merete Storgaard

^*Corresponding author for this work

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Abstract

Case-fatality rates in Ebola treatment centers (ETCs) varied widely during the Ebola virus disease (EVD) outbreak in West Africa. We assessed the influence of referral pathway on ETC case-fatality rates with a retrospective cohort of 126 patients treated at the Mathaska ETC in Port Loko, Sierra Leone. The patients consisted of persons who had confirmed EVD when transferred to the ETC or who had been diagnosed onsite. The case-fatality rate for transferred patients was 46% versus 67% for patients diagnosed onsite (p = 0.02). The difference was mediated by Ebola viral load at diagnosis, suggesting a survival selection bias. Comparisons of case-fatality rates across ETCs and clinical management strategies should account for potential survival selection bias.

Original language	English
Journal	Emerging Infectious Diseases
Volume	23
Issue number	4
Pages (from-to)	597-600
ISSN	1080-6059
DOIs	https://doi.org/10.3201/eid2304.160485
Publication status	Published - 2017

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10.3201/eid2304.160485

Influence of referral pathway on ebola virus disease case-fatality rate and effect of survival selection biasFinal published version, 432 KB

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title = "Influence of referral pathway on ebola virus disease case-fatality rate and effect of survival selection bias",

abstract = "Case-fatality rates in Ebola treatment centers (ETCs) varied widely during the Ebola virus disease (EVD) outbreak in West Africa. We assessed the influence of referral pathway on ETC case-fatality rates with a retrospective cohort of 126 patients treated at the Mathaska ETC in Port Loko, Sierra Leone. The patients consisted of persons who had confirmed EVD when transferred to the ETC or who had been diagnosed onsite. The case-fatality rate for transferred patients was 46% versus 67% for patients diagnosed onsite (p = 0.02). The difference was mediated by Ebola viral load at diagnosis, suggesting a survival selection bias. Comparisons of case-fatality rates across ETCs and clinical management strategies should account for potential survival selection bias.",

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T1 - Influence of referral pathway on ebola virus disease case-fatality rate and effect of survival selection bias

AU - Rudolf, Frauke

AU - Damkjær, Mads

AU - Lunding, Suzanne

AU - de la Cour, Kenn Dornonville

AU - Young, Alyssa

AU - Brooks, Tim

AU - Sesay, Tom

AU - Salam, Alex P.

AU - Mishra, Sharmistha

AU - Storgaard, Merete

PY - 2017

Y1 - 2017

N2 - Case-fatality rates in Ebola treatment centers (ETCs) varied widely during the Ebola virus disease (EVD) outbreak in West Africa. We assessed the influence of referral pathway on ETC case-fatality rates with a retrospective cohort of 126 patients treated at the Mathaska ETC in Port Loko, Sierra Leone. The patients consisted of persons who had confirmed EVD when transferred to the ETC or who had been diagnosed onsite. The case-fatality rate for transferred patients was 46% versus 67% for patients diagnosed onsite (p = 0.02). The difference was mediated by Ebola viral load at diagnosis, suggesting a survival selection bias. Comparisons of case-fatality rates across ETCs and clinical management strategies should account for potential survival selection bias.

AB - Case-fatality rates in Ebola treatment centers (ETCs) varied widely during the Ebola virus disease (EVD) outbreak in West Africa. We assessed the influence of referral pathway on ETC case-fatality rates with a retrospective cohort of 126 patients treated at the Mathaska ETC in Port Loko, Sierra Leone. The patients consisted of persons who had confirmed EVD when transferred to the ETC or who had been diagnosed onsite. The case-fatality rate for transferred patients was 46% versus 67% for patients diagnosed onsite (p = 0.02). The difference was mediated by Ebola viral load at diagnosis, suggesting a survival selection bias. Comparisons of case-fatality rates across ETCs and clinical management strategies should account for potential survival selection bias.

U2 - 10.3201/eid2304.160485

DO - 10.3201/eid2304.160485

M3 - Journal article

C2 - 28322693

AN - SCOPUS:85015791670

SN - 1080-6059

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EP - 600

JO - Emerging Infectious Diseases

JF - Emerging Infectious Diseases

IS - 4

ER -

Influence of referral pathway on ebola virus disease case-fatality rate and effect of survival selection bias

Abstract

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