Evans Jennifer A, May Juergen, Ansong Daniel, Antwi Sampson, Asafo-Adjei Emmanuel, Nguah Samuel Blay, Osei-Kwakye Kingsley, Akoto Alex Osei Yaw, Ofori Alex Owusu, Sambian David, Sylverken Justice, Busch Wibke, Timmann Christian, Agbenyega Tsiri, Horstmann Rolf D
Kumasi Centre for Collaborative Research in Tropical Medicine, Kumasi, Ghana.
J Pediatr. 2006 Nov;149(5):676-81. doi: 10.1016/j.jpeds.2006.07.040.
To improve algorithms for the identification of children at risk of dying of malaria in endemic areas.
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.
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.
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.
改进在疟疾流行地区识别有死于疟疾风险儿童的算法。
在对西非加纳一家三级转诊中心收治的2446例重症和复杂疟疾儿童进行的前瞻性研究中，评估了12项临床和实验室指标作为死亡指标。
除酸中毒、昏迷和呼吸窘迫外，延长（>2秒）的毛细血管再充盈时间（pCRT）被确定为死亡的独立预后指标。在临床体征中，当pCRT与昏迷和呼吸窘迫同时存在时，死亡风险从4倍增加到11倍。
将pCRT识别为死亡的独立指标，证明将其纳入重症和复杂疟疾的定义标准是合理的，并改善了疟疾患者分诊中临床检查的应用。由于pCRT已被证明可反映儿童的循环障碍，应在未来研究中作为可能表明需要静脉输液的体征纳入研究。
