Rapid Clinical Assessment to Facilitate the Triage of Adults with Falciparum Malaria, a Retrospective Analysis

Joshua Hanson, Sue J Lee, Sanjib Mohanty, Abul Faiz, Nicholas Anstey, Ric Price, Prakaykaew Charunwatthana, Emran Bin Yunus, Saroj Mishra, Emiliana Tjitra, Ridwanur Rahman, François Nosten, Ye Htut, Richard Maude, Tran Thi Hong Chau, Nguyen Hoan Phu, Tran Tinh Hien, Nicholas J 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
Pages (from-to)1-11
Number of pages11
JournalPLoS One
Volume9
Issue number1
DOIs
Publication statusPublished - 29 Jan 2014

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Falciparum Malaria
Triage
malaria
confidence interval
Confidence Intervals
Survival
Anuria
coma
Patients' Rooms
patient care
hypoglycemia
hyperglycemia
Critical Care
Respiratory Rate
Coma
pathophysiology
Hypoglycemia
Hyperglycemia
fever
Shock

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Hanson, Joshua ; Lee, Sue J ; Mohanty, Sanjib ; Faiz, Abul ; Anstey, Nicholas ; Price, Ric ; Charunwatthana, Prakaykaew ; Yunus, Emran Bin ; Mishra, Saroj ; Tjitra, Emiliana ; Rahman, Ridwanur ; Nosten, François ; Htut, Ye ; Maude, Richard ; Chau, Tran Thi Hong ; Phu, Nguyen Hoan ; Hien, Tran Tinh ; White, Nicholas J ; Day, Nicholas ; Dondorp, Arjen. / Rapid Clinical Assessment to Facilitate the Triage of Adults with Falciparum Malaria, a Retrospective Analysis. In: PLoS One. 2014 ; Vol. 9, No. 1. pp. 1-11.
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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.",
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author = "Joshua Hanson and Lee, {Sue J} and Sanjib Mohanty and Abul Faiz and Nicholas Anstey and Ric Price and Prakaykaew Charunwatthana and Yunus, {Emran Bin} and Saroj Mishra and Emiliana Tjitra and Ridwanur Rahman and Fran{\~A}§ois Nosten and Ye Htut and Richard Maude and Chau, {Tran Thi Hong} and Phu, {Nguyen Hoan} and Hien, {Tran Tinh} and White, {Nicholas J} and Nicholas Day and Arjen Dondorp",
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Hanson, J, Lee, SJ, Mohanty, S, Faiz, A, Anstey, N, Price, R, Charunwatthana, P, Yunus, EB, Mishra, S, Tjitra, E, Rahman, R, Nosten, F, Htut, Y, Maude, R, Chau, TTH, Phu, NH, Hien, TT, White, NJ, Day, N & Dondorp, A 2014, 'Rapid Clinical Assessment to Facilitate the Triage of Adults with Falciparum Malaria, a Retrospective Analysis', PLoS One, vol. 9, no. 1, pp. 1-11. https://doi.org/10.1371/journal.pone.0087020

Rapid Clinical Assessment to Facilitate the Triage of Adults with Falciparum Malaria, a Retrospective Analysis. / Hanson, Joshua; Lee, Sue J; Mohanty, Sanjib; Faiz, Abul; Anstey, Nicholas; Price, Ric; Charunwatthana, Prakaykaew; Yunus, Emran Bin; Mishra, Saroj; Tjitra, Emiliana; Rahman, Ridwanur; Nosten, François; Htut, Ye; Maude, Richard; Chau, Tran Thi Hong; Phu, Nguyen Hoan; Hien, Tran Tinh; White, Nicholas J; Day, Nicholas; Dondorp, Arjen.

In: PLoS One, Vol. 9, No. 1, 29.01.2014, p. 1-11.

Research output: Contribution to journalArticleResearchpeer-review

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T1 - Rapid Clinical Assessment to Facilitate the Triage of Adults with Falciparum Malaria, a Retrospective Analysis

AU - Hanson, Joshua

AU - Lee, Sue J

AU - Mohanty, Sanjib

AU - Faiz, Abul

AU - Anstey, Nicholas

AU - Price, Ric

AU - Charunwatthana, Prakaykaew

AU - Yunus, Emran Bin

AU - Mishra, Saroj

AU - Tjitra, Emiliana

AU - Rahman, Ridwanur

AU - Nosten, François

AU - Htut, Ye

AU - Maude, Richard

AU - Chau, Tran Thi Hong

AU - Phu, Nguyen Hoan

AU - Hien, Tran Tinh

AU - White, Nicholas J

AU - Day, Nicholas

AU - Dondorp, Arjen

PY - 2014/1/29

Y1 - 2014/1/29

N2 - 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.

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