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

Hanson, Josh, Lee, Sue, Mohanty, Sanjib, Faiz, Abul, Anstey, Nicholas M., Price, Ric N., Charunwatthana, Prakaykaew, Yunus, Emran, Mishra, Saroj, Tjitra, Emiliana, Rahman, Ridwanur, Nosten, Francois, Htut, Ye, Maude, Richard, Chau, Tran, Phu, Nguyen, Hien, Tran, White, Nicholas J., Day, Nicholas P. J. and Dondorp, Arjen M. (2014). Rapid clinical assessment to facilitate the triage of adults with falciparum malaria, a retrospective analysis. PLoS One,9(1 - Article No. e87020).

Document type: Journal Article
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Title Rapid clinical assessment to facilitate the triage of adults with falciparum malaria, a retrospective analysis
Author Hanson, Josh
Lee, Sue
Mohanty, Sanjib
Faiz, Abul
Anstey, Nicholas M.
Price, Ric N.
Charunwatthana, Prakaykaew
Yunus, Emran
Mishra, Saroj
Tjitra, Emiliana
Rahman, Ridwanur
Nosten, Francois
Htut, Ye
Maude, Richard
Chau, Tran
Phu, Nguyen
Hien, Tran
White, Nicholas J.
Day, Nicholas P. J.
Dondorp, Arjen M.
Journal Name PLoS One
Publication Date 2014
Volume Number 9
Issue Number 1 - Article No. e87020
ISSN 1932-6203   (check CDU catalogue open catalogue search in new window)
Scopus ID 2-s2.0-84900425990
Total Pages 11
Place of Publication United States of America
Publisher Public Library of Science
HERDC Category C1 - Journal Article (DIISR)
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.
DOI http://dx.doi.org/10.1371/journal.pone.0087020   (check subscription with CDU E-Gateway service for CDU Staff and Students  check subscription with CDU E-Gateway in new window)


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