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Title: Rapid clinical assessment to facilitate the triage of adults with falciparum malaria, a retrospective analysis
Authors: Josh Hanson
Sue J. Lee
Sanjib Mohanty
M. Abul Faiz
Nicholas M. Anstey
Ric N. Price
Prakaykaew Charunwatthana
Emran Bin Yunus
Saroj K. Mishra
Emiliana Tjitra
Ridwanur Rahman
Francois Nosten
Ye Htut
Richard J. Maude
Tran Thi Hong Chau
Nguyen Hoan Phu
Tran Tinh Hien
Nicholas J. White
Nicholas P.J. Day
Arjen M. Dondorp
Mahidol University
Menzies School of Health Research
Churchill Hospital
Ispat Hospital
Dev Care Foundation
Chittagong Medical College
Badan Penelitian Dan Pengembangan Kesehatan, Kementerian Kesehatan Republik Indonesia
Shaheed Sharwardhy Medical College
Shoklo Malaria Research Unit
Lower Myanmar
Keywords: Agricultural and Biological Sciences;Biochemistry, Genetics and Molecular Biology
Issue Date: 29-Jan-2014
Citation: PLoS ONE. Vol.9, No.1 (2014)
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. © 2014 Hanson et al.
ISSN: 19326203
Appears in Collections:Scopus 2011-2015

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