title: Capillary refill time as an independent prognostic indicator in severe and complicated malaria.
abstract: 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.
authors.affiliation: Kumasi Centre for Collaborative Research in Tropical Medicine, Kumasi, Ghana. evans@kccr.de
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Evans
authors.forename: Juergen
authors.initials: J
authors.lastname: May
authors.forename: Daniel
authors.initials: D
authors.lastname: Ansong
authors.forename: Sampson
authors.initials: S
authors.lastname: Antwi
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Asafo-Adjei
authors.forename: Samuel Blay
authors.initials: SB
authors.lastname: Nguah
authors.forename: Kingsley
authors.initials: K
authors.lastname: Osei-Kwakye
authors.forename: Alex Osei Yaw
authors.initials: AO
authors.lastname: Akoto
authors.forename: Alex Owusu
authors.initials: AO
authors.lastname: Ofori
authors.forename: David
authors.initials: D
authors.lastname: Sambian
authors.forename: Justice
authors.initials: J
authors.lastname: Sylverken
authors.forename: Wibke
authors.initials: W
authors.lastname: Busch
authors.forename: Christian
authors.initials: C
authors.lastname: Timmann
authors.forename: Tsiri
authors.initials: T
authors.lastname: Agbenyega
authors.forename: Rolf D
authors.initials: RD
authors.lastname: Horstmann
mesh_terms: 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
chemical_list: D015415:Biomarkers