A prospective evaluation of a clinical algorithm for the diagnosis of malaria in Gambian children
A prospective evaluation of a clinical algorithm for the diagnosis of malaria in Gambian children
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DOI：
10.1046/j.1365-3156.2000.00538.x
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发表时间：
2000-04-01
影响因子：
3.3
通讯作者：
Greenwood, BM
中科院分区：
文献类型：
--
作者：
Bojang, KA;Obaro, S;Greenwood, BM
临床疟疾的诊断仍然很困难，特别是在无症状人口中寄生虫病比例很高的地区，因为疟疾的症状和体征与其他常见儿童疾病，如急性下呼吸道感染的症状和体征重叠。然而，对冈比亚法拉芬尼保健中心一组最近有发热史的儿童的症状和体征进行的一项研究发现，与其他发热性疾病相比，一组体征和症状是疟疾的强有力预测因素。使用这些预测因子，开发了一种算法，该算法可由现场工作人员使用，并且对于疟疾的诊断具有与经验丰富的儿科医生在没有实验室支持的情况下工作的灵敏度和特异性相似的灵敏度和特异性。该算法已在518名儿童中进行了前瞻性验证，这些儿童在冈比亚Basse的医学研究理事会诊所就诊，有发热或最近10个月内有发热史。一名现场工作人员从每个孩子的父母或监护人那里获得了详细的病史，并进行了临床检查，包括测量腋窝温度和呼吸频率。测量红细胞压积，并检查厚涂片是否有疟原虫。根据疟疾相关体征和症状的存在或不存在，确定了在高传播季节在诊所就诊的382名儿童的疟疾评分。使用在先前的回顾性研究中最佳的截止分数，获得了诊断疟疾的70%的灵敏度和77%的特异性。Basse人群的最佳临界评分为7分;这给出了88%的灵敏度和62%的特异性，这些数字与经验丰富的儿科医生在没有实验室支持的情况下获得的结果相当。
Diagnosis of clinical malaria remains difficult, especially in areas where a high proportion of the asymptomatic population have parasitaemia, for the symptoms and signs of malaria overlap with those of other common childhood diseases, such as acute lower respiratory tract infections. However, a study of symptoms and signs in a group of children who presented to Farafenni Health Centre, The Gambia with a history of recent fever identified a group of signs and symptoms which were strong predictors of malaria as opposed to other febrile illnesses. Using these predictors, an algorithm was developed which could be used by fieldworkers and which had a similar sensitivity and specificity for the diagnosis of malaria as that of an experienced paediatrician working without laboratory support. This algorithm has been validated prospectively on 518 children who presented to the Medical Research Council clinic at Basse, The Gambia with fever or a history of recent fever during a 10-month period. A fieldworker obtained a detailed history from the parent or guardian of each child and performed a clinical examination which included measurement of axillary temperature and respiratory rate. Packed cell volume was measured and a thick smear was examined for malaria parasites. A malaria score, based on the presence or absence of malaria-related signs and symptoms, was determined for 382 children who were seen at the clinic during the high transmission season. Using the cut-off score which was optimal during the previous retrospective study, a sensitivity of 70% and a specificity of 77% for a diagnosis of malaria was obtained. The optimal cut-off score for the Basse population was a score of 7; this gave a sensitivity of 88% and a specificity of 62%, figures comparable to those obtained by an experienced paediatrician without laboratory support.