New Ebola guidelines address immediate supportive care

Two new studies offer insight into how to care for patients during the next Ebola outbreak, including recommendations for hydration, monitoring, testing, and pain relief as part of supportive care.

A new study based on the 2013-2016 West African Ebola outbreak, the world's largest, states that patients need immediate oral hydration when first hospitalized for Ebola virus, but that human-to-human transmission is low when personal protective gear is used appropriately.

The study, by a team of international experts, was published yesterday in The Lancet. The authors write that at the beginning of the outbreak in 2013, case-fatality rates were 70%, but that number was lowered significantly (to 40%) as supportive care practices improved over the course of the outbreak. Using Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology, the authors present evidence-based recommendations for patient care during the next Ebola outbreak.

Oral hydration and intravenous hydration had the strongest recommendation. When administered properly, the measure carries no risk of transmission to healthcare workers, the experts say. and making sure patients, especially the very young, are adequately hydrated is a necessary supportive measure.

Having enough medical staff, at least one doctor for four patients, was also strongly suggested. Patients should be assessed three times per day and should be continuously monitored.

Finally, the authors also recommended prompt use of analgesics and antibiotics as necessary.

Risk scores for diagnosing Ebola

Another study, published in Emerging Infectious Diseases, used retrospective data from 252 Ebola-positive and 172 Ebola-negative patients at a Sierra Leone Ebola treatment center to develop easy-to-use risk scores "based on symptoms and laboratory tests (if available), to stratify triaged patients by their likelihood of having Ebola infection."

Because Ebola patients can have symptoms similar to cholera and yellow fever, among other diseases, the researchers tracked the most common clinical and lab-based markers of Ebola virus. These markers can help quickly help establish an Ebola diagnosis in rural settings, where rapid Ebola testing isn't widely available.   

Positive Ebola diagnosis corresponded most often with headache, diarrhea, difficulty breathing, nausea and vomiting, loss of appetite, and conjunctivitis. The laboratory tests most useful were creatinine, creatine kinase, alanine aminotransferase, and total bilirubin. The risk scores developed by the researchers correctly identified 92% of Ebola-positive patients as being at high risk for infection.

"Our risk scores cannot replace the WHO case definition or actual diagnostic testing. They can, however, help fill the gap between a broad case definition and an often-lengthy diagnostic process, which is valuable for several reasons," the authors wrote. "Until a reliable rapid [point-of-care] diagnostic for Ebola is readily available in low-resource settings, a flexible risk score that is easy to implement can be a useful tool for further triaging patients."

See also:

Oct 17 Lancet study

Oct 18 Emerg Infect Dis study

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