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

Joshua Hanson, Sue Lee, Sanjib Mohanty, Md. Faiz, Nicholas Anstey, Ric Price, Prakaykaew Charunwatthana, Emran Yunus, Saroj Mishra, Emiliana Tjitra, Ridwanur Rahman, Francois Nosten, Ye Htut, Richard Maude, Tran Thi Hong Chau, Nguyenhoan Phu, Tran Hien, Nicholas White, Nicholas Day, Arjen Dondorp

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    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.

    Original languageEnglish
    Article numbere87020
    Number of pages11
    JournalPLoS One
    Volume9
    Issue number1
    DOIs
    Publication statusPublished - 2014

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    Hanson, J., Lee, S., Mohanty, S., Faiz, M., Anstey, N., Price, R., Charunwatthana, P., Yunus, E., Mishra, S., Tjitra, E., Rahman, R., Nosten, F., Htut, Y., Maude, R., Hong Chau, T. T., Phu, N., Hien, T., White, N., Day, N., & Dondorp, A. (2014). Rapid clinical assessment to facilitate the triage of adults with falciparum malaria, a retrospective analysis. PLoS One, 9(1), [e87020]. https://doi.org/10.1371/journal.pone.0087020