Risk classification:
(1) high risk of dying
(2) intermediate risk
(3) low risk
Clinical findings of high risk malaria - one or more of the following:
(1) any depression in consciousness
(2) current seizure activity
(3) irregular respirations
(4) obstructed airway, including pooling of saliva and/or vomit in mouth
(5) oxygen saturation < 95%
(6) shock (see below)
(7) clinical dehydration
(8) serum glucose < 54 mg/dL or < 3 mmol/L (hypoglycemia)
(9) base deficit > 8 mmol/L (metabolic acidosis)
(10) potassium > 5.5 mmol/L (severe hyperkalemia)
Shock is diagnosed if one or both of the following are present:
(1) hypotension
(1a) systolic blood pressure < 70 mm Hg if < 1 year of age
(1b) systolic blood pressure < 80 mm Hg if >= 1 year of age
(2) 2 or more of the following:
(2a) tachycardia
(2b) increased work of breathing
(2c) cool hands or feet
(2d) capillary refill time >= 3 seconds
(2e) temperature gradient between core and distal extremity (such as toe)
Clinical findings of intermediate risk malaria - one or more of the following:
(1) hemoglobin < 10 g/dL
(2) history of convulsions during illness (not active seizure activity)
(3) parasitemia > 5% (hyperparasitemia)
(4) clinical jaundice
(5) sickle cell disease
Clinical findings of low risk malaria:
(1) neither high nor intermediate risk (none of the above features)
|
Risk Group
|
Other Factors
|
Management Triage
|
|
high
|
NA
|
needs intensive care
|
|
intermediate
|
NA
|
needs high dependency care
|
|
low
|
vomiting OR not taking oral medications
|
admit and give parenteral medication
|
|
low
|
not vomiting AND able to take oral medications
|
place on observation and give oral medications
|
where:
• I did not see an age range specified. Previous algorithms have indicated that children at risk in tropical countries are < 10 years of age.
