Overview :

Maitland et al classified the risk to a pediatric patient in the United Kingdom with malaria. This can help identify a child who may require more aggressive management. The authors are from the Kenya Medical Research Institute, Wellcome Trust, St. Mary's Hospital (London), University of Oxford and University of Sussex.

Risk classification:

(1) high risk of dying

(2) intermediate risk

(3) low risk

Clinical findings of high risk malaria - one or more of the following:

(1) any depression in consciousness

(2) current seizure activity

(3) irregular respirations

(4) obstructed airway, including pooling of saliva and/or vomit in mouth

(5) oxygen saturation < 95%

(6) shock (see below)

(7) clinical dehydration

(8) serum glucose < 54 mg/dL or < 3 mmol/L (hypoglycemia)

(9) base deficit > 8 mmol/L (metabolic acidosis)

(10) potassium > 5.5 mmol/L (severe hyperkalemia)

Shock is diagnosed if one or both of the following are present:

(1) hypotension

(1a) systolic blood pressure < 70 mm Hg if < 1 year of age

(1b) systolic blood pressure < 80 mm Hg if >= 1 year of age

(2) 2 or more of the following:

(2a) tachycardia

(2b) increased work of breathing

(2c) cool hands or feet

(2d) capillary refill time >= 3 seconds

(2e) temperature gradient between core and distal extremity (such as toe)

Clinical findings of intermediate risk malaria - one or more of the following:

(1) hemoglobin < 10 g/dL

(2) history of convulsions during illness (not active seizure activity)

(3) parasitemia > 5% (hyperparasitemia)

(4) clinical jaundice

(5) sickle cell disease

Clinical findings of low risk malaria:

(1) neither high nor intermediate risk (none of the above features)

where:

• I did not see an age range specified. Previous algorithms have indicated that children at risk in tropical countries are < 10 years of age.

Maitland K, Nadel S, et al. Management of severe malaria in children: proposed guidelines for the United Kingdom. BMJ. 2005; 331: 337-343 (Box 1, page 338).