Hanson et al developed a series of simple scores for evaluating an adult for malaria. These can help to identify patients who may benefit from more aggressive management. The authors are from multiple universities and hospitals in Asia, Australia and England.
Patient selection: adult admitted to the hospital with severe malaria
Parameters:
(1) Glasgow coma score (GCS)
(2) base deficit in mmol/L
(3) respiratory rate in breaths per minute
(4) serum bicarbonate in mmol/L
|
Parameter
|
Finding
|
Points
|
|
Glasgow Coma Score
|
15
|
0
|
|
|
11 to 14
|
1
|
|
|
3 to 10
|
2
|
|
base deficit
|
< 2
|
0
|
|
|
2 to 9.9
|
1
|
|
|
>= 10
|
2
|
|
respiratory rate
|
1 to 19
|
0
|
|
|
20 to 39
|
1
|
|
|
>= 40
|
2
|
|
serum bicarbonate
|
>= 24
|
0
|
|
|
15 to 23.9
|
1
|
|
|
< 15
|
2
|
Coma Acidosis Malaria (CAM) score =
= (points for GCS) + (points for base deficit)
bicarbonate Coma Acidosis Malaria (BCAM) score =
= (points for GCS) + (points for serum bicarbonate)
respiratory rate Coma Acidosis Malaria (RCAM) score =
= (points for GCS) + (points for respiratory rate)
Interpretation:
• minimum score: 0
• maximum score: 4
• The higher the score the more deranged the patient's physiologic state.
• A patient with a score of 0 or 1 on hospital admission can be managed on a general ward. However, development of renal failure was associated with a worse prognosis.
|
CAM
|
Mortality Rate
|
|
0 or 1
|
< 10%
|
|
2
|
15-20%
|
|
3
|
30%
|
|
4
|
50-60%
|
Performance:
• A score of 0 or 1 had a 96% positive predictive value (PPV) for survival.
