Development of clinical decision tools for management of diarrhea of children in high and low resource settings

摘要 腹泻病是全世界儿童死亡的主要原因之一，大多数发生在 低收入国家。在高收入国家，儿科腹泻仍然是医疗保健的主要用途。 资源。腹泻的治疗大多是经验性的，抗生素的使用大多基于临床怀疑 细菌引起的。然而，大多数腹泻病例并没有从抗生素的使用中受益，而且 不适当的使用会导致毒性和耐药性。此外，尽管快速服务的可用性越来越高， 在分子测试方面，几乎没有数据来决定测试对象或测试时间。我们的首要目标是 开发和验证临床决策工具，用于管理高和低收入儿童的腹泻疾病 资源设置较低。我们将利用最近完成的两个多中心的前瞻性收集数据 儿童腹泻的队列研究。这些研究的特点是广泛的病原学测试，良好的临床特征 要素和纵向结果数据。我们已经组建了一支在儿科腹泻方面具有专业知识的团队， 临床预测规则和机器学习方法。在目标1中，我们将利用国内数据开发和 验证：a)细菌病原学评分，b)患者可能从进一步的治疗中受益的评分 测试。我们将使用Impact的数据得出分数，Impact是一项由NIH赞助的研究，研究对象是来自5个国家的1200名儿童 美国急诊部，并使用犹他州山间健康中心的电子健康记录进行验证 系统。在目标2中，我们将使用国际数据来开发和验证：a)细菌的诊断评分 病因学，以及b)预后不良儿童的风险分层的预后评分。我们将派生出 使用来自GEMS的数据，对7个低资源国家的9400多名儿童进行的研究，并验证了这些分数 使用VIDA对3个非洲国家的儿童进行研究。目标的完成将导致提供一个 世界各地的医护人员可以使用的临床工具的数量，用于以证据为基础的儿童护理 拉肚子。

Abstract Diarrheal diseases are the among the leading cause of death in children worldwide, most of which occur in low-income countries. In high-income countries, pediatric diarrhea remains a major utilization of healthcare resources. Treatment of diarrhea is mostly empiric, with antibiotic use mostly based on clinical suspicion for bacterial causes. However, the majority of cases of diarrhea do not benefit from antibiotic use, and inappropriate use leads to toxicity and resistance. Furthermore, despite the increasing availability of rapid molecular testing, there is little data to base a decision of whom or when to test. Our overarching goal is to develop and validate clinical decision tools for management of diarrheal illnesses in children of both high and low resource settings. We will utilize prospectively-collected data from two recently-completed multicenter cohort studies of pediatric diarrhea. These studies feature extensive etiologic testing, well-characterized clinical elements, and longitudinal outcome data. We have assembled a team with expertise in pediatric diarrhea, clinical prediction rules, and machine learning methods. In Aim 1, we will use domestic data to develop and validate: a) a score for bacterial etiology, and b) a score for which patients are likely to benefit from further testing. We will derive the scores using data from IMPACT, an NIH-sponsored study of 1200 children from 5 US Emergency Departments, and validate using electronic health records from the Utah Intermountain Health System. In Aim 2, we will use international data to develop and validate: a) a diagnostic score for bacterial etiology, and b) a prognostic score for risk stratification of children who go on to poor outcomes. We will derive the scores using data from GEMS, a study of over 9400 children across 7 low-resource countries, and validate using VIDA study of children in 3 African countries. Completion of the Aims will result in the availability of a number of clinical tools that healthcare workers worldwide can use for evidence-based care of children with diarrhea.