Development of a novel mobile health tool for age-specific dehydration assessment and management in patients with diarrheal disease

开发一种新型移动健康工具，用于腹泻病患者的特定年龄脱水评估和管理

• 批准号: 10202572
• 负责人: Adam Carl Levine
• 金额: $ 54.68万
• 依托单位: RHODE ISLAND HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-09-01 至 2023-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10202572
• 关键词: 5 year old; Acute Diarrhea; Adolescent; Adult; Adverse event; Age; Algorithms; Bangladesh; Beds; Body Weight Changes; Car Phone; Caring; Cause of Death; Cessation of life; Child; Childhood; Clinical; Clinical Trials; Cost Savings; Data; Dehydration; Development; Diagnosis; Diagnostic; Diarrhea; Discipline of Nursing; Elderly; Enrollment; Ensure; Etiology; Future; Health; Health Personnel; Health care facility; Healthcare; Hospitalization; IV Fluid; Individual; Inpatients; International Unit; Ischemia; Lead; Liquid substance; Machine Learning; Measures; Modeling; Morbidity - disease rate; Nurses; Oral; Organ; Outpatients; Patients; Performance; Physicians; Physiological; Physiology; Population; Prospective cohort; Provider; Rehydration Solutions; Rehydrations; Research; Resources; Resuscitation; Severities; Signs and Symptoms; Symptoms; Techniques; Work; World Health Organization; accurate diagnosis; age group; base; clinical diagnostics; clinical examination; clinical predictors; cost effectiveness; design; diagnostic accuracy; diarrheal disease; experience; hemodynamics; improved; innovation; international center; low and middle-income countries; mHealth; mortality; novel; patient population; prevent; success; tool; usability

Project Summary Diarrheal diseases lead to an estimated 2.4 billion episodes of illness and 1.3 million deaths each year, with the majority of those deaths occurring in adults, adolescents, and children over five years. As the severity of diarrheal diseases can vary widely, accurately assessing dehydration status remains the most crucial step in preventing morbidity and mortality. While patients with severe dehydration require hospital admission and immediate resuscitation with intravenous fluids to prevent hemodynamic compromise, organ ischemia, and death, those with mild to moderate dehydration can be treated in outpatient settings with relatively inexpensive oral rehydration solution. Yet, while several tools have been validated for use in children under five years of age, no clinical diagnostic tool has ever been validated for the assessment of dehydration severity in adults, adolescents or children over five years of age with acute diarrhea. Differences in both adult physiology and diarrhea etiology may compromise the accuracy of clinical diagnostic models developed for use in young children. The proposed research will derive the very first age-specific clinical diagnostic models created for the assessment of dehydration status in patients over five years of age with acute diarrhea, incorporate those models into a new mobile health (mHealth) tool, and validate the performance of this tool in a new population of patients with acute diarrhea. To accomplish this task, we will enroll a prospective cohort of adults and children over five years of age with acute diarrhea presenting to the rehydration unit of the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) in Dhaka, Bangladesh and collect data on presenting clinical signs and symptoms shown to correlate with dehydration severity in prior studies. We will then employ machine learning techniques to derive age-specific clinical diagnostic models for assessing dehydration in patients over five years of age with acute diarrhea. We will conduct formative research among clinicians working at icddr,b to develop an innovative mobile phone based platform which will incorporate these new age-specific diagnostic models for rapid use by frontline health workers. Finally, we will validate both the accuracy and reliability of the newly developed mHealth tool in a new population of adults and children over five years of age with acute diarrhea. Once developed and properly validated, this novel mHealth tool has the potential to help physicians, nurses, and other healthcare providers more accurately diagnose dehydration severity and better determine the optimal management strategy for patients with acute diarrhea. Improved diagnostic approaches may in turn be shown to reduce both the morbidity and mortality that occurs as a result of missed diagnoses of dehydration, as well as the adverse events and inappropriate utilization of limited healthcare resources that can result from inaccurate diagnoses of dehydration.

项目摘要 腹泻疾病估计每年估计有24亿次疾病和130万人死亡，其中有130万人 大多数死亡发生在成年人，青少年和儿童五年中。作为严重性 腹泻疾病可能很大变化，准确评估脱水状态仍然是最关键的 一步防止发病率和死亡率。而严重脱水的患者需要医院 使用静脉输液进行入院和立即复苏，以防止血液动力学妥协，器官 缺血和死亡，患有轻度至中度脱水的人可以在门诊环境中治疗 相对便宜的口服补液解决方案。然而，尽管已验证了几种用于儿童的工具 五岁以下，从未对任何临床诊断工具进行验证以评估 急性腹泻的成年人，青少年或儿童的脱水严重程度。 成人生理学和腹泻病因的差异可能会损害临床诊断的准确性 开发用于幼儿的模型。拟议的研究将得出第一个特定年龄的研究 为评估五岁以上患者的脱水状况而创建的临床诊断模型 使用急性腹泻，将这些模型纳入新的移动健康（MHealth）工具中，并验证该模型 该工具在新的急性腹泻患者中的性能。 为了完成这项任务，我们将招募一个预期的成年人和五岁以上的儿童 急性腹泻向国际腹泻疾病研究中心的补液部门呈现， 孟加拉的孟加拉国（ICDDR，b），孟加拉国，收集有关显示临床体征和症状的数据 在先前的研究中与脱水严重程度相关。然后，我们将使用机器学习技术 得出针对年龄特异性的临床诊断模型，用于评估五岁以上患者的脱水 急性腹泻。我们将对在ICDDR工作的临床医生进行B的形成性研究，以开发 创新的基于手机的平台将合并这些新的年龄特定诊断模型 一线卫生工作者的快速使用。最后，我们将验证新近的准确性和可靠性 在急性腹泻的五岁以上的新成年人和儿童中，开发了MHealth工具。 一旦开发并得到了适当的验证，这种新颖的MHealth工具就有可能帮助医生， 护士和其他医疗保健提供者更准确地诊断脱水严重程度，更好 确定急性腹泻患者的最佳管理策略。改进的诊断 反过来，可能证明方法可以降低由于错过而发生的发病率和死亡率 诊断脱水，不良事件和不适当利用有限的医疗保健 脱水诊断可能导致的资源。