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

Issued Date

2014-01-29

Resource Type

Article

ISSN

19326203

DOI

10.1371/journal.pone.0087020

Other identifier(s)

2-s2.0-84900425990

Rights

Mahidol University

Rights Holder(s)

SCOPUS

Bibliographic Citation

PLoS ONE. Vol.9, No.1 (2014)

Suggested Citation

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 Rapid clinical assessment to facilitate the triage of adults with falciparum malaria, a retrospective analysis. PLoS ONE. Vol.9, No.1 (2014). doi:10.1371/journal.pone.0087020 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/33063

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Title

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

Author(s)

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

Other Contributor(s)

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
 UCL

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.

Keyword(s)

Agricultural and Biological Sciences
 Biochemistry, Genetics and Molecular Biology

Availability

URI

https://repository.li.mahidol.ac.th/handle/20.500.14594/33063

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