INDICATORS OF LIFE-THREATENING MALARIA IN AFRICAN CHILDREN
INDICATORS OF LIFE-THREATENING MALARIA IN AFRICAN CHILDREN
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DOI：
10.1056/nejm199505253322102
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发表时间：
1995-05-25
影响因子：
158.5
通讯作者：
SNOW, R
中科院分区：
文献类型：
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作者：
MARSH, K;FORSTER, D;SNOW, R
背景资料。大约90%的疟疾死亡者是非洲儿童，但指导识别和管理严重疟疾的标准尚未在他们身上得到验证。我们对肯尼亚一家地区医院儿科病房的所有初步诊断为疟疾的儿童进行了一项前瞻性研究。我们计算了当前世界卫生组织(WHO)对重症疟疾定义中每个临床和实验室标准的频率和死亡率，然后使用Logistic回归分析确定预后价值最大的变量。我们研究了1844名被初步诊断为疟疾的儿童(平均年龄26.4个月)，未包括18名抵达时死亡的儿童和4名死于其他原因的儿童。死亡率为3.5%(95%可信区间为2.7%至4.3%)，84%的死亡发生在入院24小时内。Logistic回归分析确定了四个关键的预后指标：意识受损(相对风险为3.3；95%可信区间为1.6至7.0)、呼吸窘迫(相对风险为3.9；95%可信区间为2.0至7.7)、低血糖(相对风险为3.3；95%可信区间为1.6至6.7)和黄疸(相对风险为2.6；95%可信区间为1.1至6.3)。在死亡的儿童中，有54人患有意识障碍(n=336，病死率为11.9%)和/或呼吸窘迫(n=251，病死率为13.9%)。因此，这个简单的床边指数确定了84.4%的死亡病例，而目前世界卫生组织的标准确定了79.7%。在患有疟疾的非洲儿童中，意识受损或呼吸窘迫的存在可以确定那些死亡风险较高的人。
Background. About 90 percent of the deaths from malaria are in African children, but criteria to guide the recognition and management of severe malaria have not been validated in them.Methods. We conducted a prospective study of all children admitted to the pediatric ward of a Kenyan district hospital with a primary diagnosis of malaria. We calculated the frequency and mortality rate for each of the clinical and laboratory criteria in the current World Health Organization (WHO) definition of severe malaria, and then used logistic-regression analysis to identify the variables with the greatest prognostic value.Results. We studied 1844 children (mean age, 26.4 months) with a primary diagnosis of malaria, Not included were 18 children who died on arrival and 4 who died of other causes. The mortality rate was 3.5 percent (95 percent confidence interval, 2.7 to 4.3 percent), and 84 percent of the deaths occurred within 24 hours of admission. Logistic-regression analysis identified four key prognostic indicators: impaired consciousness (relative risk, 3.3; 95 percent confidence interval, 1.6 to 7.0), respiratory distress (relative risk, 3.9; 95 percent confidence interval, 2.0 to 7.7), hypoglycemia (relative risk, 3.3; 95 percent confidence interval, 1.6 to 6.7), and jaundice (relative risk, 2.6; 95 percent confidence interval, 1.1 to 6.3). Of the 64 children who died, 54 were among those with impaired consciousness (n = 336; case fatality rate, 11.9 percent) or respiratory distress (n = 251; case fatality rate, 13.9 percent), or both. Hence, this simple bedside index identified 84.4 percent of the fatal cases, as compared with the 79.7 percent identified by the current WHO criteria.Conclusions. In African children with malaria, the presence of impaired consciousness or respiratory distress can identify those at high risk for death.