Capillary refill time as an independent prognostic indicator in severe and complicated malaria.
OBJECTIVE
To improve algorithms for the identification of children at risk of dying of malaria in endemic areas.


METHODS
In a prospective study of 2446 children with severe and complicated malaria admitted to a tertiary referral center in Ghana, West Africa, 12 clinical and laboratory signs were evaluated as indicators of death.


RESULTS
A prolonged (> 2 seconds) capillary refill time (pCRT) was identified as an independent prognostic indicator of death along with acidosis, coma, and respiratory distress. Among the clinical signs, pCRT increased the risk of dying from 4-fold to 11-fold when present in addition to coma and respiratory distress.


CONCLUSIONS
The recognition of pCRT as an independent indicator of death justifies its inclusion as a defining criterion of severe and complicated malaria and improves the use of clinical examinations in the triage of patients with malaria. As pCRT has been shown to reflect circulatory disturbances in children, it should be included in upcoming studies as a possible sign to indicate the need for intravenous fluid administration.
Evans
Jennifer A
JA
Kumasi Centre for Collaborative Research in Tropical Medicine, Kumasi, Ghana. evans@kccr.de
May
Juergen
J
Ansong
Daniel
D
Antwi
Sampson
S
Asafo-Adjei
Emmanuel
E
Nguah
Samuel Blay
SB
Osei-Kwakye
Kingsley
K
Akoto
Alex Osei Yaw
AO
Ofori
Alex Owusu
AO
Sambian
David
D
Sylverken
Justice
J
Busch
Wibke
W
Timmann
Christian
C
Agbenyega
Tsiri
T
Horstmann
Rolf D
RD
D000138:Acidosis / Q000401:mortality / Q000503:physiopathology; D000293:Adolescent; D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D000740:Anemia / Q000401:mortality / Q000503:physiopathology; D015415:Biomarkers / Q000097:blood; D002200:Capillary Resistance; D002648:Child; D002675:Child, Preschool; D003128:Coma / Q000401:mortality / Q000503:physiopathology; D005260:Female; D005869:Ghana / Q000453:epidemiology; D006339:Heart Rate; D006801:Humans; D008288:Malaria / Q000401:mortality / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D018512:Parasitemia / Q000401:mortality / Q000503:physiopathology; D011379:Prognosis; D011446:Prospective Studies; D012131:Respiratory Insufficiency / Q000401:mortality / Q000503:physiopathology; D012307:Risk Factors; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D015996:Survival Rate; D013997:Time Factors
D015415:Biomarkers