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Overview :
Olaleye et al developed scores for identifying a child with
fever or a history of fever who probably has malaria and not some other disease.
The scores were developed in Gambia and are intended to use minimal laboratory
testing. The authors are from Gambia, Geneva and London.
Patient selection: child from 6 months to 9 years with fever or
history of fever
Parameters (10, of which only 9 are used for each of the
scores):
(1) sleepy
(2) feeding
(3) cough
(4) shivering
(5) feeling hot
(6) cough not heard
(7) pallor of palm
(8) absence of rash
(9) respiratory rate
(10) spleen
If the patient a parasitemia >= 5,000 per µL and temperature
>= 38°C then coefficients in Column A are used.
If the patient a parasitemia >= 5,000 per µL and temperature
< 38°C then coefficients in Column B are used.
|
Parameter |
Finding |
Points |
Column A |
Column B |
|
feeling sleepy |
absent |
0 |
0 |
0 |
|
|
present |
1 |
0.56 |
0 |
|
feeding |
normal |
0 |
0 |
0 |
|
|
reduced |
1 |
0.77 |
0.81 |
|
cough |
absent |
1 |
1.00 |
1.03 |
|
|
present |
0 |
0 |
0 |
|
shivering |
absent |
0 |
0 |
0 |
|
|
present |
1 |
0.56 |
0.97 |
|
feeling hot |
absent |
0 |
0 |
0 |
|
|
present |
1 |
3.45 |
0 |
|
silent cough |
absent |
0 |
0 |
0 |
|
|
present |
1 |
1.33 |
1.21 |
|
pallor of palm |
absent |
0 |
0 |
0 |
|
|
present |
1 |
0.89 |
0.89 |
|
rash |
absent |
1 |
1.50 |
1.52 |
|
|
present |
0 |
0 |
0 |
|
respiratory rate |
normal or decreased |
0 |
0 |
0 |
|
|
increased |
1 |
1.12 |
0.75 |
|
spleen |
normal |
0 |
0 |
0 |
|
|
enlarged |
1 |
0 |
1.08 |
score based on number of signs and symptoms present =
= SUM(points for all 10 terms)
score based on the sum of the rounded regression coefficients
=
= SUM(ROUND(coefficients for all 10 terms to integers)
score based on the sum of the regression coefficients =
= SUM(nonrounded coefficients for all 10 terms)
Interpretation:
• minimum
number of signs and symptoms: 0
• maximum
number of signs and symptoms: 9 for column A and 8 for column B
• maximum
score for column A with coefficients: 11.18
• maximum
score for column B with coefficients: 8.26
• maximum
score for column A with coefficients rounded: 12
• maximum
score for column B with coefficients rounded: 9
• The child
was said to have malaria if the number of signs and symptoms was >= 6 or if
the sum of the rounded coefficients was >= 8.
• Looking at
the data in Table 4 the cutoff for the unrounded coefficients would be >=
9.
Performance:
• The
sensitivity for the selected cutoff for signs and symptoms was 89% and
specificity was 61%.
• The
sensitivity for the selected cutoff for signs and symptoms was 88% and
specificity was 64%.
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