Division of Infectious Diseases and International Health, Department of Medicine, Duke University Medical Center, Durham, NC 27710, USA.
Arch Dis Child. 2012 Oct;97(10):889-94. doi: 10.1136/archdischild-2012-301812. Epub 2012 Aug 7.
As the proportion of children living low malaria transmission areas in sub-Saharan Africa increases, approaches for identifying non-malarial severe illness need to be evaluated to improve child outcomes.
As a prospective cohort study, we identified febrile paediatric inpatients, recorded data using Integrated Management of Childhood Illness (IMCI) criteria, and collected diagnostic specimens.
Tertiary referral centre, northern Tanzania.
Of 466 participants with known outcome, median age was 1.4 years (range 2 months-13.0 years), 200 (42.9%) were female, 11 (2.4%) had malaria and 34 (7.3%) died. Inpatient death was associated with: Capillary refill >3 s (OR 9.0, 95% CI 3.0 to 26.7), inability to breastfeed or drink (OR 8.9, 95% CI 4.0 to 19.6), stiff neck (OR 7.0, 95% CI 2.8 to 17.6), lethargy (OR 5.2, 95% CI 2.5 to 10.6), skin pinch >2 s (OR 4.8, 95% CI 1.9 to 12.3), respiratory difficulty (OR 4.0, 95% CI 1.9 to 8.2), generalised lymphadenopathy (OR 3.6, 95% CI 1.6 to 8.3) and oral candidiasis (OR 3.4, 95% CI 1.4 to 8.3). BCS <5 (OR 27.2, p<0.001) and severe wasting (OR 6.9, p<0.001) were independently associated with inpatient death.
In a low malaria transmission setting, IMCI criteria performed well for predicting inpatient death from non-malarial illness. Laboratory results were not as useful in predicting death, underscoring the importance of clinical examination in assessing prognosis. Healthcare workers should consider local malaria epidemiology as malaria over-diagnosis in children may delay potentially life-saving interventions in areas where malaria is uncommon.
随着撒哈拉以南非洲儿童生活在低疟疾传播地区的比例增加，需要评估识别非疟疾严重疾病的方法，以改善儿童预后。
作为一项前瞻性队列研究，我们确定了发热的儿科住院患者，使用儿童疾病综合管理（IMCI）标准记录数据，并收集诊断标本。
坦桑尼亚北部的三级转诊中心。
在已知结局的 466 名参与者中，中位年龄为 1.4 岁（范围 2 个月至 13.0 岁），200 名（42.9%）为女性，11 名（2.4%）患有疟疾，34 名（7.3%）死亡。住院死亡与以下因素相关：毛细血管再充盈时间>3 秒（OR 9.0，95%CI 3.0 至 26.7），无法哺乳或饮水（OR 8.9，95%CI 4.0 至 19.6），颈项强直（OR 7.0，95%CI 2.8 至 17.6），嗜睡（OR 5.2，95%CI 2.5 至 10.6），皮肤捏合时间>2 秒（OR 4.8，95%CI 1.9 至 12.3），呼吸困难（OR 4.0，95%CI 1.9 至 8.2），全身淋巴结肿大（OR 3.6，95%CI 1.6 至 8.3）和口腔念珠菌病（OR 3.4，95%CI 1.4 至 8.3）。BCS<5（OR 27.2，p<0.001）和严重消瘦（OR 6.9，p<0.001）与住院死亡独立相关。
在低疟疾传播环境中，IMCI 标准在预测非疟疾疾病住院死亡方面表现良好。实验室结果在预测死亡方面没有那么有用，这强调了临床检查在评估预后方面的重要性。卫生保健工作者应考虑当地疟疾流行病学，因为在疟疾不常见的地区，对儿童的疟疾过度诊断可能会延迟潜在的救命干预措施。
