von Seidlein et al evaluated African children with severe falciparum malaria. They identified predictors of mortality which can help to identify a child who may benefit from more aggressive management. The authors are from multiple hospitals in Africa, Australia, Thailand and England.
Patient selection: African child < 15 years old with severe falciparum malaria (one or more of: coma, prostration, convulsions, shock, severe respiratory distress, hypoglycemia, severe symptomatic anemia, blackwater fever, jaundice, hyperparasitemia)
Outcome: mortality
Parameters:
(1) base excess in mmol/L
(2) BUN in mg/dL
(3) combined coma score (based on Blantyre Coma Scale and Glasgow Coma Score, ranges from 1 to 5 with 1unresponsive and 5 fully responsive but not fully described)
(4) chronic disease (lymphadenopathy, malnutrition, severe visible wasting, Candidiasis, desquamation)
(5) convulsions (>= 30 minutes or >= 2 episodes in the 24 hour before admission)
|
Parameter |
Finding |
Points |
|
base excess |
>= -8 mmol/L |
0 |
|
|
< -8 mmol/L (metabolic acidosis) |
1 |
|
BUN |
< 20 mg/dL |
0 |
|
|
>= 20 mg/dL |
1 |
|
combined coma score |
>= 3 |
0 |
|
|
< 3 |
1 |
|
chronic disease |
absent |
0 |
|
|
present |
1 |
|
Convulsions |
absent |
0 |
|
|
present |
1 |
total score =
= SUM(points for all 5 parameters)
Interpretation:
• minimum score: 0
• maximum score: 5
• The higher the score the greater the mortality.
|
Score |
Mortality |
|
0 |
1% |
|
1 |
5% |
|
2 |
11% |
|
3 |
30% |
|
4 |
53% |
|
5 |
67% |
Specialty: Infectious Diseases
