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The prognostic utility of bedside assessment of adults hospitalized with malaria in Myanmar: a retrospective analysis

Kaung, Myat, Kyi, Tint Tint, Aung, Ne Myo, Kyaw, Myat Phone, Min, Myo, Htet, Zaw Win, Anstey, Nicholas M., Kyi, Mar Mar and Hanson, Josh (2015). The prognostic utility of bedside assessment of adults hospitalized with malaria in Myanmar: a retrospective analysis. Malaria Journal,14(Article No. 63).

Document type: Journal Article
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IRMA ID 75039815xPUB786
Title The prognostic utility of bedside assessment of adults hospitalized with malaria in Myanmar: a retrospective analysis
Author Kaung, Myat
Kyi, Tint Tint
Aung, Ne Myo
Kyaw, Myat Phone
Min, Myo
Htet, Zaw Win
Anstey, Nicholas M.
Kyi, Mar Mar
Hanson, Josh
Journal Name Malaria Journal
Publication Date 2015
Volume Number 14
Issue Number Article No. 63
ISSN 1475-2875   (check CDU catalogue  open catalogue search in new window)
Scopus ID 2-s2.0-84924023992
Total Pages 9
Place of Publication United Kingdom
Publisher BioMed Central Ltd.
HERDC Category C1 - Journal Article (DIISR)
Abstract Background
Data collected in clinical trials have been used to develop scoring systems that identify adults with malaria at greatest risk of death. One of these, the RCAM score, can be simply determined by measuring a patient’s Glasgow Coma Score and respiratory rate on admission to hospital. However the safety of using the RCAM score to define high-risk patients has not been assessed outside of the clinical trial setting.

Methods
A retrospective audit of medical records of all adults admitted with a diagnosis of malaria to two tertiary referral hospitals in Lower Myanmar in 2013 was undertaken. An RCAM score was calculated in all patients and related to their subsequent clinical course.

Results
The recent decline in malaria hospitalizations at both sites continued in 2013. During the year 90 adults were hospitalized with malaria; 62 (69%) had Plasmodium falciparum mono-infection, 11 (12%) had Plasmodium vivax mono-infection, 17 (19%) had mixed infection. All seven (7.7%) deaths occurred in patients infected with P. falciparum. An admission RCAM score <2 identified all the patients that would survive to discharge (positive predictive value (95% confidence interval (CI)) 100% (94.9-100%) and also predicted a requirement for less supportive care: 9/70 (13%) patients with an admission RCAM score <2 required supportive care (blood transfusion, vasopressor support or oxygen supplementation) during their hospitalization compared with 12/20 (60%) patients with an admission RCAM score ≥2 (p < 0.0001). No patient with P. vivax mono-infection required supportive care during their hospitalization. Patients with an oxygen saturation ≤95% on room air on admission were more likely to die before discharge (odds ratio 17.3 (95% CI: 2.9-101.2) than patients with a higher oxygen saturation (p = 0.002).

Conclusions
Even outside a clinical trial setting the RCAM score reliably identifies adults with malaria who are at greatest risk of death and can be safely used in the initial triage and management of these patients.
Keywords Severe malaria
Clinical prediction tools
Myanmar
Pulse oximetry
Vivax malaria
DOI http://dx.doi.org/10.1186/s12936-015-0549-y   (check subscription with CDU E-Gateway service for CDU Staff and Students  check subscription with CDU E-Gateway in new window)
Additional Notes This is an Open Access article distributed under the terms of the Creative Commons Attribution License 4.0, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Description for Link Link to CC Attribution 4.0 License
URL https://creativecommons.org/licenses/by/4.0/au


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