Development of a multi-organ dysfunction scoring system to assess severity of illness in children with severe malaria

Lead Research Organisation: MRC Unit, The Gambia

Abstract

Severe malaria is a significant cause of childhood morbidity and mortality. There are currently no signs or symptoms that can effectively predict outcome. The mechanisms that cause severe malaria remain poorly understood. It is however known to affect the various systems of the body to different degrees. The ability to identify these changes early may help in defining the extent of care given. This is particularly important in places where there are no sophisticated facilities which incidentally would comprise most of the areas where these children are likely to present.||Scoring systems have been developed in many aspects of clinical care for different disease and some have been verified in adults with severe malaria but not in children. This study aims to try and identify changes in function of the various systems of the body by collecting routine data on clinical and laboratory findings. It is hoped that the data collected would be used in developing a scoring system which can be used in areas with limited facilities to detect early those with potential risk of poor outcome. This would help to focus limited resources on those who really need it.

Technical Summary

Severe malaria remains a significant health challenge accounting for over one million deaths in African children. Since most of these deaths occur within 24 hours of presentation to referral hospitals, these therefore require some form of intensive care and in areas of limited resources, allocating these is usually based on subjective assessment by the health staff.||Severe malaria is increasingly being recognized as a multi-systemic process rather than involvement of a single organ /system; the extent of involvement of the various systems contributing significantly to morbidity and mortality.||Due to its similarity to other multi systemic diseases, we hypothesize that it should be possible to assess the level of severity in children with severe malaria using a scoring system. Being able to identify those at particular high risk among the complicated cases of malaria upon admission would allow targeting limited resources to those that need it most. Most of the available scoring systems heavily rely on more sophisticated laboratory based parameters, such as arterial blood gasses that aren't readily available in resource poor settings. The study aims to develop a scoring system based on clinical and basic laboratory parameters. Data collected at admission will be correlated with any complications occurring during the course of disease, and disease outcome, to see if any combination of parameters would have been able to predict complications or disease outcome.||Available data will also be used in an attempt to develop a Bayesian network that could facilitate identification of cases at high risk based on parameters assessed on admission.

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