Arnold et al identified a number of risk factors for shock in a patient admitted to the hospital with severe falciparum malaria. These can help to identify a patient who may benefit from more aggressive management. The authors are from Mahidol University in Bangkok, Thailand.
Patient selection: severe falciparum malaria
Outcome: shock
Parameters:
(1) gender
(2) red cell distribution width (RDW)
(3) anorexia
(4) hypoalbuminemia
(5) BUN to creatinine ratio
Parameter
Finding
Points
gender
male
0
female
1
RDW
<= 15%
0
> 15%
1
anorexia
absent
0
present
1
hypoalbuminemia
absent
0
present
1
BUN to creatinine ratio
<= 20
0
> 20
1
number of risk factors for shock =
= SUM(points for all 5 parameters)
Interpretation:
• minimum number of risk factors: 0
• maximum number of risk factors: 5
• The risk for shock increases with the number of risk factors identified.
The presence of diarrhea was protective (odds ratio 0.33). In the implementation the presence of diarrhea was subtracted from the risk score given above.
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