Vital Sign alterations within 24 hours prior to death in children with retinopathy-positive Cerebral Malaria at Queen Elizabeth Central Hospital Malawi

IF 1.2 4区 医学 Q4 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH
Milcent Chintsanya, Charlotte Talham, Bo Zhang, Terrie E. Taylor, K. Seydel
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引用次数: 0

Abstract

BackgroundMalaria is a significant obstacle to child health and survival. Plasmodium falciparum infections, especially in children under five, lead to high morbidity and mortality. Cerebral malaria (CM) is a life-threatening complication characterized by coma, and its diagnosis can be improved by observing malarial retinopathy in children. Monitoring vital signs is essential for managing patients with CM.ObjectivesTo determine if changes in vital signs predict death in children with retinopathy positive cerebral malaria (RPCM). MethodsThis was a retrospective case-control study using data collected from children admitted to the Paediatric Research Ward at Queen Elizabeth Central Hospital in Blantyre between 1997 and 2020. Patients who died 24 hours or more after admission were matched with control patients who survived. Linear regression analyses were used to assess the differential time trends of each vital sign in the survivor group and death group. Classification models were used to quantify various vital signs’ predictive power of death.Results Among the population that died, the estimated change in average respiratory rate per hour approaching death was 0.02 breaths per minute compared to -0.25 breaths per minute among those who survive (p < 0.001), and the estimated change in average BCS per hour approaching death was -0.01 compared to 0.06 among the survivors (p < 0.001). Changes in temperature and heart rate were not associated with clinical deterioration. Three models were developed, and the best receiver operating characteristic curve was 100% sensitive, the corresponding false positive rate was 75%. ConclusionChanges in respiratory rate and BCS have prognostic significance in the final 24 hours before death in children with cerebral malaria. Extra attention should be paid to these two vital signs as they may help to identify children who are at increased risk of deteriorating.
马拉维伊丽莎白女王中央医院视网膜病变阳性脑疟疾患儿死亡前 24 小时内的生命体征变化
背景疟疾是儿童健康和生存的重大障碍。恶性疟原虫感染,尤其是五岁以下儿童的感染,导致很高的发病率和死亡率。脑疟疾(CM)是一种以昏迷为特征的危及生命的并发症,通过观察儿童的疟原虫视网膜病变可以提高诊断率。目标确定生命体征的变化是否可预测视网膜病变阳性脑疟疾(RPCM)患儿的死亡。方法这是一项回顾性病例对照研究,使用的数据来自 1997 年至 2020 年间布兰太尔伊丽莎白女王中央医院儿科研究病房收治的儿童。入院 24 小时或更长时间后死亡的患者与存活的对照组患者进行了配对。线性回归分析用于评估存活组和死亡组中每个生命体征的不同时间趋势。结果 在死亡人群中,临近死亡时每小时平均呼吸频率的估计变化为每分钟 0.02 次,而存活者为每分钟-0.25 次(P < 0.001);临近死亡时每小时平均 BCS 的估计变化为-0.01 次,而存活者为 0.06 次(P < 0.001)。体温和心率的变化与临床恶化无关。建立了三个模型,最佳接收器操作特征曲线的灵敏度为 100%,相应的假阳性率为 75%。结论在脑型疟疾患儿死亡前的最后 24 小时内,呼吸频率和 BCS 的变化具有预后意义。应格外关注这两个生命体征,因为它们有助于识别病情恶化风险增加的患儿。
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来源期刊
Malawi Medical Journal
Malawi Medical Journal Medicine-General Medicine
CiteScore
1.50
自引率
0.00%
发文量
27
审稿时长
>12 weeks
期刊介绍: Driven and guided by the priorities articulated in the Malawi National Health Research Agenda, the Malawi Medical Journal publishes original research, short reports, case reports, viewpoints, insightful editorials and commentaries that are of high quality, informative and applicable to the Malawian and sub-Saharan Africa regions. Our particular interest is to publish evidence-based research that impacts and informs national health policies and medical practice in Malawi and the broader region. Topics covered in the journal include, but are not limited to: - Communicable diseases (HIV and AIDS, Malaria, TB, etc.) - Non-communicable diseases (Cardiovascular diseases, cancer, diabetes, etc.) - Sexual and Reproductive Health (Adolescent health, education, pregnancy and abortion, STDs and HIV and AIDS, etc.) - Mental health - Environmental health - Nutrition - Health systems and health policy (Leadership, ethics, and governance) - Community systems strengthening research - Injury, trauma, and surgical disorders
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