INITIAL CLINICAL-ASSESSMENT OF THE COMATOSE PATIENT - CEREBRAL MALARIA VS MENINGITIS
INITIAL CLINICAL-ASSESSMENT OF THE COMATOSE PATIENT - CEREBRAL MALARIA VS MENINGITIS
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DOI：
10.1097/00006454-199301000-00009
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发表时间：
1993-01-01
影响因子：
3.6
通讯作者：
MCLARTY, JW
中科院分区：
文献类型：
--
作者：
WRIGHT, PW;AVERY, WG;MCLARTY, JW
121 名处于昏迷状态的利比里亚儿童被送往利比里亚蒙罗维亚的 ELWA 医院。将腰椎穿刺前的入院诊断与出院诊断进行比较。 94 名儿童出院时最终诊断为脑型疟疾，27 名儿童诊断为脑膜炎。脑型疟疾患者的入院诊断正确率为 76.6%（94 例中的 72 例），脑膜炎患者的入院诊断正确率为 59.3%（27 例中的 16 例）。脑脊液白细胞计数是确定正确诊断的最重要因素。在不进行脑脊液分析的情况下，区分准确度（77%），即明确区分两种疾病，与医生入院诊断（73%）相当。其他有助于脑型疟疾和脑膜炎鉴别诊断的数据包括入院前发烧天数、颈项强直是否存在、囟门饱满度和外周血疟疾涂片。脑型疟疾和脑膜炎的死亡率分别为 14.9% 和 29.6%。这些数据表明，如果不进行脑脊液分析，医生就无法可靠地区分脑型疟疾和脑膜炎。
One hundred twenty-one Liberian children were admitted in coma to the ELWA Hospital, Monrovia, Liberia. Admitting diagnoses, before lumbar puncture, were compared with discharge diagnoses. Ninety-four children were discharged with a final diagnosis of cerebral malaria and 27 with a diagnosis of meningitis. The admitting diagnosis was correct in 76.6% (72 of 94) of patients with cerebral malaria and 59.3% (16 of 27) of patients with meningitis. The cerebrospinal fluid leukocyte count was the single most significant factor in determining the correct diagnosis. Without the cerebrospinal fluid analysis, the discriminant accuracy (77%), i.e. definitive separation of the two illnesses, was comparable to the physician's admission diagnosis (73%). Other data contributing to the differential diagnosis of cerebral malaria and meningitis included the number of days of fever before admission, the presence or absence of nuchal rigidity, fontanelle fullness and peripheral blood malaria smear. Mortality rates for cerebral malaria and meningitis-were 14.9 and 29.6%, respectively. These data suggest that physicians cannot reliably discriminate between cerebral malaria and meningitis without cerebrospinal fluid analysis.