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PLoS One. 2014 Jan 29;9(1):e87020. doi: 10.1371/journal.pone.0087020. eCollection 2014.

Rapid clinical assessment to facilitate the triage of adults with falciparum malaria, a retrospective analysis.

Author information

1
Mahidol Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand ; Global Health Division, Menzies School of Health Research, Darwin, Australia.
2
Mahidol Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand ; Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, Churchill Hospital, Oxford, United Kingdom.
3
Department of Medicine, Ispat Hospital, Rourkela, Orissa, India.
4
Mahidol Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand ; Dev Care Foundation, Dhaka, Bangladesh.
5
Global Health Division, Menzies School of Health Research, Darwin, Australia.
6
Global Health Division, Menzies School of Health Research, Darwin, Australia ; Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, Churchill Hospital, Oxford, United Kingdom.
7
Mahidol Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand.
8
Chittagong Medical College, Chittagong, Bangladesh.
9
National Institute of Health Research and Development, Ministry of Health, Jakarta, Indonesia.
10
Shaheed Sharwardhy Medical College, Dhaka, Bangladesh.
11
Mahidol Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand ; Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, Churchill Hospital, Oxford, United Kingdom ; Shoklo Malaria Research Unit, Mae Sot, Thailand.
12
Department of Medical Research, Lower Myanmar, Ministry of Health, Yangon, Myanmar.
13
Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam.

Abstract

BACKGROUND:

Most adults dying from falciparum malaria will die within 48 hours of their hospitalisation. An essential component of early supportive care is the rapid identification of patients at greatest risk. In resource-poor settings, where most patients with falciparum malaria are managed, decisions regarding patient care must frequently be made using clinical evaluation alone.

METHODS:

We retrospectively analysed 4 studies of 1801 adults with severe falciparum malaria to determine whether the presence of simple clinical findings might assist patient triage.

RESULTS:

If present on admission, shock, oligo-anuria, hypo- or hyperglycaemia, an increased respiratory rate, a decreased Glasgow Coma Score and an absence of fever were independently predictive of death. The variables were used to construct a simple clinical algorithm. When applied to the 1801 patients, this algorithm's positive predictive value for survival to 48 hours was 99.4 (95% confidence interval (CI) 97.8-99.9) and for survival to discharge 96.9% (95% CI 94.3-98.5). In the 712 patients receiving artesunate, the algorithm's positive predictive value for survival to 48 hours was 100% (95% CI 97.3-100) and to discharge was 98.5% (95% CI 94.8-99.8).

CONCLUSIONS:

Simple clinical findings are closely linked to the pathophysiology of severe falciparum malaria in adults. A basic algorithm employing these indices can facilitate the triage of patients in settings where intensive care services are limited. Patients classified as low-risk by this algorithm can be safely managed initially on a general ward whilst awaiting senior clinical review and laboratory data.

PMID:
24489828
PMCID:
PMC3906099
DOI:
10.1371/journal.pone.0087020
[Indexed for MEDLINE]
Free PMC Article
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