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Overview :
Idro et al evaluated children with acute falciparum malaria in
Kenya. They identified a number of risk factors for neurologic involvement and
mortality. The authors are from multiple hospitals in Kenya, Uganda and
England.
Patient selection: age < 14 years with falciparum malaria
Neurologic involvement includes:
(1) seizures
(2) agitation
(3) prostration
(4) reduced level of consciousness, including coma
Risk factors for neurological involvement (adjusted odds ratios
ranging from 1.6 to 3.7):
(1) history of seizures in the past
(2) fever lasting <= 2 days at time of admission
(3) delayed capillary refill (increased by > 2 seconds)
(4) metabolic acidosis (base deficity > 8 mmol/L)
(5) hypoglycemia
Factors reducing the risk of neurological involvement:
(1) one or more comorbid conditions (in addition to the
malaria)
(2) severe anemia
Risk factors for mortality (adjusted odds ratios ranging from
2.5 to 5):
(1) reduced level
of consciousness
(2) respiratory
distress (sustained nasal flaring, deep acidotic breathing, subcostal
retractions)
(3) severe anemia
(4) hypoglycemia
(5) hyperkalemia
(> 5 mmol/L)
(6) bacteremia
(7) seizures after
hospital admission
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