Publication: Rapid clinical assessment to facilitate the triage of adults with falciparum malaria, a retrospective analysis.
Accepted Date
2013-12-15
Issued Date
2014-01-29
Copyright Date
2014
Resource Type
Language
eng
ISSN
1932-6203 (electronic)
Rights
Mahidol University
Rights Holder(s)
PLOS ONE
Bibliographic Citation
Hanson J, Lee SJ, Mohanty S, Faiz MA, Anstey NM, Price RN, et al. Rapid clinical assessment to facilitate the triage of adults with falciparum malaria, a retrospective analysis. PLoS One. 2014 Jan 29;9(1):e87020.
Suggested Citation
Hanson, Josh, Lee, Sue J., Mohanty, Sanjib, Faiz, M. Abul, Anstey, Nicholas M., Price, Ric N., Prakaykaew Charunwatthana, ประกายแก้ว จรูญวรรธนะ, Yunus, Emran Bin, Mishra, Saroj K., Tjitra, Emiliana, Ridwanur Rahman, Francois Nosten, Htut, Ye, Maude, Richard J., Chau, Tran Thi Hong, Phu, Nguyen Hoan, Hien, Tran Tinh, White, Nicholas J., Day, Nicholas P. J., Dondorp, Arjen M. Rapid clinical assessment to facilitate the triage of adults with falciparum malaria, a retrospective analysis.. Hanson J, Lee SJ, Mohanty S, Faiz MA, Anstey NM, Price RN, et al. Rapid clinical assessment to facilitate the triage of adults with falciparum malaria, a retrospective analysis. PLoS One. 2014 Jan 29;9(1):e87020.. doi:10.1371/journal.pone.0087020. Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/794
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Title
Rapid clinical assessment to facilitate the triage of adults with falciparum malaria, a retrospective analysis.
Author(s)
Hanson, Josh
Lee, Sue J.
Mohanty, Sanjib
Faiz, M. Abul
Anstey, Nicholas M.
Price, Ric N.
Prakaykaew Charunwatthana
ประกายแก้ว จรูญวรรธนะ
Yunus, Emran Bin
Mishra, Saroj K.
Tjitra, Emiliana
Ridwanur Rahman
Francois Nosten
Htut, Ye
Maude, Richard J.
Chau, Tran Thi Hong
Phu, Nguyen Hoan
Hien, Tran Tinh
White, Nicholas J.
Day, Nicholas P. J.
Dondorp, Arjen M.
Lee, Sue J.
Mohanty, Sanjib
Faiz, M. Abul
Anstey, Nicholas M.
Price, Ric N.
Prakaykaew Charunwatthana
ประกายแก้ว จรูญวรรธนะ
Yunus, Emran Bin
Mishra, Saroj K.
Tjitra, Emiliana
Ridwanur Rahman
Francois Nosten
Htut, Ye
Maude, Richard J.
Chau, Tran Thi Hong
Phu, Nguyen Hoan
Hien, Tran Tinh
White, Nicholas J.
Day, Nicholas P. J.
Dondorp, Arjen M.
Corresponding Author(s)
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.