Development of a Mobile Health Personalized Physiologic Analytics Tool for Pediatric Patients with Sepsis

为脓毒症儿科患者开发移动健康个性化生理分析工具

• 批准号: 10671864
• 负责人: Adam Carl Levine
• 金额: $ 12.3万
• 依托单位: RHODE ISLAND HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-08-10 至 2023-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10671864
• 关键词: Bangladesh; Cessation of life; Child; Child Mortality; Climate; Clinical; Collaborations; Communicable Diseases; Communities; Country; Critically ill children; Data; Development; Diagnosis; Disease Outbreaks; Droughts; Elderly; Electronic Health Record; Equilibrium; Floods; Functional disorder; Habitats; Healthcare Systems; Hospitals; Human; Immune response; Incidence; Infection; Intensive Care Units; Intervention; Knowledge; Lead; Life; Link; Literature; Multiple Organ Failure; Organ; Outcome; Parents; Patient Care; Patients; Physiological; Policy Maker; Public Health; Research; Research Personnel; Resources; Respiratory Disease; Rhode Island; Sepsis; Septic Shock; Severities; Temperature; Work; analytical tool; base; climate change; climate impact; climate-related health; diarrheal disease; disease transmission; enteric infection; evidence base; improved; individual patient; international center; low and middle-income countries; mHealth; mortality; mortality risk; patient subsets; pediatric patients; pediatric sepsis; predictive modeling; trend

Project Summary Sepsis, defined as life-threatening organ dysfunction caused by a dysregulated host response to infection, encompasses a continuum that ranges from sepsis to severe sepsis, septic shock, multiple organ dysfunction syndrome (MODS) and eventually death if untreated. Sepsis is the leading cause of child mortality worldwide, with most of these deaths occurring in low and middle-income countries (LMICs). Climatic changes are closely linked to infectious diseases, which lead to sepsis in a subset of patients; for instance, rising temperatures, increased flooding, and droughts, and changing habitats may tip the ecological balance, encouraging infectious disease transmission and triggering outbreaks, such as enteric infections and diarrhea and respiratory diseases. Those living in the world’s poorest communities, particularly children and the elderly, are likely to suffer the most from escalations in climate-susceptible infectious diseases. However, despite both the greater vulnerability to climate change and the higher rates of child mortality from sepsis in these settings, there is a paucity of literature on the effects of climate change on sepsis and sepsis outcomes in LMICs. In particular, Bangladesh has been identified as one of the most vulnerable countries in the world to climate change threats. The proposed research will build additional aims related to climate change and health onto the parent R21/R33 study, “Development of a Mobile Health Personalized Physiologic Analytics Tool for Pediatric Patients with Sepsis” (R21 TW012211). We will evaluate the impact of climate trends on pediatric sepsis incidence, severity and mortality rate using data collected from the parent study of pediatric patients with sepsis admitted to the intensive care unit the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) Dhaka Hospital, as well as electronic health record (EHR) data from all pediatric patients diagnosed with sepsis at the icddr,b Dhaka Hospital. Knowledge gained from this study will greatly advance the evidence base for the impact of climate and changing climate trends on critically ill children with sepsis in Bangladesh which may be applicable to other similar LMIC settings. This work also has the potential to improve the clinical prediction models for sepsis severity and risk of death that we are creating, and thereby inform clinicians of the impacts of climate on individual patient care. The proposed initiatives will also build a base of technical and professional expertise at Rhode Island Hospital and icddr,b in climate change and health research which will allow future research and collaborations to study the impacts of climate change on sepsis and infectious diseases. Increased research on the intersection of climate and sepsis, particularly in children, may allow researchers, clinicians and policy makers to best plan how to strengthen healthcare systems, better allocate scarce human and material resources, and develop interventions to support patients and communities in adapting and mitigating these public health threats.

项目摘要 脓毒症，定义为由宿主对感染的反应失调引起的危及生命的器官功能障碍， 包括从脓毒症到严重脓毒症、脓毒性休克、多器官功能障碍 多器官功能障碍综合征（MODS），如果不治疗，最终死亡。脓毒症是全世界儿童死亡的主要原因， 其中大多数死亡发生在低收入和中等收入国家（LMIC）。气候变化与 与感染性疾病有关，导致一部分患者出现败血症;例如，温度升高， 洪水和干旱的增加以及栖息地的变化可能会破坏生态平衡，鼓励传染病 疾病传播和引发疫情，如肠道感染、腹泻和呼吸道感染 疾病那些生活在世界上最贫穷社区的人，特别是儿童和老年人， 易受气候影响的传染病不断升级，使这些国家受害最深。然而，尽管两者都更大， 由于易受气候变化的影响，以及这些环境中败血症造成的儿童死亡率较高， 缺乏关于气候变化对中低收入国家脓毒症和脓毒症结局影响的文献。特别是， 孟加拉国被认为是世界上最容易受到气候变化威胁的国家之一。 拟议的研究将在母体R21/R33上建立与气候变化和健康相关的额外目标 研究，“开发一个移动的健康个性化生理分析工具，用于儿科患者， 败血症”（R21 TW 012211）。我们将评估气候趋势对儿童脓毒症发病率、严重程度 和死亡率，使用的数据收集自母研究的儿科败血症患者入院， 孟加拉国国际腹泻病研究中心（icddr，B）重症监护室达卡 医院，以及电子健康记录（EHR）数据，从所有儿科患者诊断为败血症，在 icddr，B达卡医院。从这项研究中获得的知识将大大推进证据基础， 气候和气候变化趋势对孟加拉国败血症重症儿童的影响， 适用于其他类似的LMIC设置。这项工作也有可能提高临床预测 我们正在创建的脓毒症严重程度和死亡风险模型，从而告知临床医生 气候对个别病人护理。拟议的举措还将建立一个技术和专业基础， 罗得岛医院和icddr，B在气候变化和健康研究方面的专业知识， 研究和合作，研究气候变化对败血症和传染病的影响。 增加对气候和败血症的交叉研究，特别是在儿童中，可能会让研究人员， 临床医生和政策制定者最好地计划如何加强医疗保健系统，更好地分配稀缺的人力资源， 和物质资源，并制定干预措施，以支持病人和社区适应和 减轻这些公共卫生威胁。