Justine Lanneaux1, Stéphane Dauger1, Luu-Ly Pham2, Jérôme Naudin1, Albert Faye3, Yves Gillet4, Emmanuelle Bosdure5, Ricardo Carbajal6, François Dubos7, Renaud Vialet8, Gérard Chéron9, François Angoulvant9,10. 1. Department of Paediatric Intensive care, AP-HP, Hôpital Robert Debré, Université Paris Diderot, Sorbonne Paris Cité, Paris, France. 2. Paediatric Emergency Department, AP-HP, Hôpital Bicêtre, Université Paris Sud, Le Kremlin-Bicêtre, France. 3. Department of General Paediatrics, AP-HP, Hôpital Robert Debré, Université Paris Diderot, Sorbonne Paris Cité, Paris, France. 4. Paediatric Emergency Department, HCL, HFME Lyon, Université de Lyon 1, Lyon, France. 5. Department of Paediatrics, APHM, CHU Timone Enfants, Marseille, France. 6. Paediatric Emergency Department, AP-HP, Hôpital Armand Trousseau, Université Pierre et Marie Curie Paris 6, Paris, France. 7. Paediatric Emergency and Infectious Diseases Departments, Université de Lille, Hôpital R. Salengro, Centre Hospitalier Régional Universitaire de Lille, Lille, France. 8. Paediatric Intensive Care Department, APHM, CHU Nord, Marseille, France. 9. Paediatric Emergency Department, AP-HP, Hôpital Necker-Enfants Malades, Université Paris Descartes, Sorbonne Paris Cité, Paris, France. 10. Clinical Epidemiology Unit ECEVE, INSERM UMR 1123, AP-HP, Hôpital Robert Debré, Université Paris Diderot, Sorbonne Paris Cité, Paris, France.
Abstract
OBJECTIVE: The World Health Organization (WHO) severity criteria for paediatric Plasmodium falciparum (Pf) malaria are based on studies in countries of endemic malaria. The relevance of these criteria for other countries remains unclear. We assessed the relevance of these criteria in an industrialised country. DESIGN: Retrospective case-control study. SETTING: Eight French university hospitals, from 2006 to 2012. PATIENTS: Children with Pf malaria admitted to paediatric intensive care units (cases: n=55) or paediatric emergency departments (controls: n=110). MAIN OUTCOME MEASURES: Descriptive analysis of WHO severity criteria and major interventions (mechanical ventilation, blood transfusion, fluid challenge, treatment of cerebral oedema, renal replacement therapy). Thresholds were set by receiver operating characteristics curve analysis. RESULTS: Altered consciousness (71% vs 5%), shock (24% vs 1%), renal failure (20% vs 1%), anaemia <50 g/L (7% vs 2%), acidosis (38% vs 0%), bilirubin level >50 µmol/L (25% vs 8%) and parasitaemia >10% (30% vs 8%) were more frequent in cases (p<0.01). All these criteria were associated with major interventions (p<0.001). Respiratory distress (six cases), and hypoglycaemia (two cases) were infrequent. Thrombocytopenia <50 000/mm3 (46% vs 7%) and anaemia (haemoglobin concentration <70 g/L (41% vs 13%)) were more frequent in cases (p<0.0001). CONCLUSIONS: The WHO severity criteria for paediatric Pf malaria are relevant for countries without endemic malaria. The infrequent but severe complications also provide a timely reminder of the morbidity and mortality associated with this condition worldwide. In non-endemic countries haemoglobin <70 g/L and platelet count <50 000/mm3 could be used as additional criteria to identify children needing high level of care. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.
OBJECTIVE: The World Health Organization (WHO) severity criteria for paediatric Plasmodium falciparum (Pf) malaria are based on studies in countries of endemic malaria. The relevance of these criteria for other countries remains unclear. We assessed the relevance of these criteria in an industrialised country. DESIGN: Retrospective case-control study. SETTING: Eight French university hospitals, from 2006 to 2012. PATIENTS: Children with Pfmalaria admitted to paediatric intensive care units (cases: n=55) or paediatric emergency departments (controls: n=110). MAIN OUTCOME MEASURES: Descriptive analysis of WHO severity criteria and major interventions (mechanical ventilation, blood transfusion, fluid challenge, treatment of cerebral oedema, renal replacement therapy). Thresholds were set by receiver operating characteristics curve analysis. RESULTS: Altered consciousness (71% vs 5%), shock (24% vs 1%), renal failure (20% vs 1%), anaemia <50 g/L (7% vs 2%), acidosis (38% vs 0%), bilirubin level >50 µmol/L (25% vs 8%) and parasitaemia >10% (30% vs 8%) were more frequent in cases (p<0.01). All these criteria were associated with major interventions (p<0.001). Respiratory distress (six cases), and hypoglycaemia (two cases) were infrequent. Thrombocytopenia <50 000/mm3 (46% vs 7%) and anaemia (haemoglobin concentration <70 g/L (41% vs 13%)) were more frequent in cases (p<0.0001). CONCLUSIONS: The WHO severity criteria for paediatric Pfmalaria are relevant for countries without endemic malaria. The infrequent but severe complications also provide a timely reminder of the morbidity and mortality associated with this condition worldwide. In non-endemic countries haemoglobin <70 g/L and platelet count <50 000/mm3 could be used as additional criteria to identify children needing high level of care. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.
Authors: James A Watson; Carolyne M Ndila; Thomas N Williams; Chris C Holmes; Nicholas J White; Sophie Uyoga; Alexander Macharia; Gideon Nyutu; Shebe Mohammed; Caroline Ngetsa; Neema Mturi; Norbert Peshu; Benjamin Tsofa; Kirk Rockett; Stije Leopold; Hugh Kingston; Elizabeth C George; Kathryn Maitland; Nicholas Pj Day; Arjen M Dondorp; Philip Bejon Journal: Elife Date: 2021-07-06 Impact factor: 8.140