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.

项目概要 据估计，腹泻病每年导致 24 亿次发病和 130 万人死亡，其中 其中大部分死亡发生在五年以上的成人、青少年和儿童中。由于严重程度 腹泻疾病差异很大，准确评估脱水状态仍然是最重要的 预防发病率和死亡率的步骤。虽然严重脱水的患者需要住院治疗 入院并立即用静脉输液进行复苏，以防止血流动力学损害、器官 缺血和死亡，轻度至中度脱水的患者可以在门诊接受以下治疗： 相对便宜的口服补液。然而，尽管有几种工具已被验证可用于儿童 对于五岁以下的儿童，目前还没有经过验证的临床诊断工具可用于评估 患有急性腹泻的成人、青少年或五岁以上儿童的脱水严重程度。 成人生理学和腹泻病因学的差异可能会影响临床诊断的准确性 为幼儿使用而开发的模型。拟议的研究将得出第一个特定年龄 为评估五岁以上患者脱水状态而创建的临床诊断模型 患有急性腹泻，将这些模型纳入新的移动健康（mHealth）工具中，并验证 该工具在新的急性腹泻患者群体中的表现。 为了完成这项任务，我们将招募一组由成人和五岁以上儿童组成的前瞻性队列 急性腹泻就诊于国际腹泻病研究中心的补液部门， 孟加拉国 (icddr,b) 在孟加拉国达卡收集有关所显示的临床体征和症状的数据 与先前研究中脱水严重程度相关。然后我们将利用机器学习技术来 推导年龄特异性临床诊断模型，用于评估五岁以上患者的脱水情况 急性腹泻。我们将对在 icddr,b 工作的临床医生进行形成性研究，以开发 基于创新手机的平台将整合这些新的针对特定年龄的诊断模型 一线卫生工作者快速使用。最后，我们将验证新方法的准确性和可靠性。 针对患有急性腹泻的成人和五岁以上儿童的新人群开发了移动医疗工具。 一旦开发并经过适当验证，这种新颖的移动医疗工具有潜力帮助医生， 护士和其他医疗保健提供者可以更准确地诊断脱水严重程度并更好地 确定急性腹泻患者的最佳治疗策略。改进的诊断 反过来，这些方法可能会被证明可以降低因错过治疗而导致的发病率和死亡率。 脱水诊断，以及不良事件和有限医疗保健的不当使用 脱水诊断不准确可能导致的资源。