Protocol for management of imported pediatric malaria decreases time to medication administration.
BACKGROUND
A malaria management protocol was developed and implemented at a tertiary care children's hospital in September 1999. We retrospectively evaluated children admitted with malaria 10-years preimplementation and 7-years postimplementation to determine the impact the protocol had on management and time delay to appropriate antimalarial therapy.


METHODS
This before and after study compared all admissions with the discharge diagnosis of malaria in the study period. Retrospective chart review was used to determine the time from emergency department (ED) registration to administration of antimalarial treatment. Other outcomes measured included mortality, length of hospital stay, and intensive care unit admission.


RESULTS
Fifty-eight admissions were identified during the defined period, most of which were due to Plasmodium falciparum[r] malaria. Thirty-one (53.4%) cases were before implementation of the protocol. Children were more likely to receive appropriate investigations to assess for possible severe malaria before transfer from the ED to the ward after protocol implementation (18% vs. 63%, P = 0.005). Analysis of index cases of malaria, excluding patients diagnosed after the diagnosis of a sibling, showed there was a significant reduction in time to medication administration (8 vs. 5.5 hours, P = 0.036).


CONCLUSIONS
After broad-based implementation of a malaria treatment protocol in a pediatric hospital, children received more thorough investigations, were more likely to receive therapy before leaving the ED and had a shorter delay before receiving appropriate antimalarial therapy.
Goldfarb
David M
DM
Division of Infectious Disease, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada. dgoldfarb@cheo.on.ca
Gaboury
Isabelle
I
Dayneka
Natalie
N
Saux
Nicole Le
NL
D000962:Antimalarials / Q000627:therapeutic use; D019090:Case Management / Q000458:organization & administration*; D002648:Child; D002675:Child, Preschool; D054242:Emigrants and Immigrants; D005260:Female; D006776:Hospitals, Pediatric; D006801:Humans; D007902:Length of Stay; D008288:Malaria / Q000175:diagnosis* / Q000188:drug therapy* / Q000453:epidemiology / Q000401:mortality; D008297:Male; D013997:Time Factors; D014195:Travel
D000962:Antimalarials