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Predictors of Fatal Outcome in Pediatric Cerebral Malaria

Description

The fatality rate of cerebral malaria in children is high (often in the order of 20-30%) despite aggressive therapy. Most deaths (75%) occurred within 24 hours of admission. Several clinical or laboratory indicators can be used to predict serious outcomes.


 

Indicators

Odds Ratio

cold periphery (hands and/or feet feeling colder to touch than the rest of the body)

2.7

deep coma (Blantyre coma score 0 or 1) on admission

2.0

hypoglycemia (blood glucose < 2.2 mmol/L) on admission

4.1

urea > 6.4 mmol/L

2.8

 

More than 90% of children who died had at least one of these conditions.

 

Additional indicators of death:

(1) abnormal respiratory pattern (abnormally deep or irregular breathing)

(2) rapid pulse rate (>= 160 breaths per minute)

(3) elevated AST

(4) elevated lactate

(5) multiple episodes of hypoglycemia during stay

(6) multiple convulsions during stay

 

Predictors of neurologic sequelae:

(1) multiple convulsions during stay

(2) deep coma (Blantyre coma score of 0 or 1)

(3) duration of unconsciousness


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