Bedside Prognostic Indicators of Fatal Outcome among Children with Cerebral Malaria at a Tertiary Nigerian Hospital

Abstract

Introduction: Cerebral Malaria (CM) is a severe manifestation of malaria and commonly causes poor outcomes. It affects upto one million people per year worldwide predominantly sub-Saharan African children. It is clinically expedient that children with CM are identified promptly and easily to halt fatal outcomes. Aim: To evaluate bedside prognostic indicators of poor outcome among children with CM. Materials and Methods: A prospective, observational study was conducted at LAUTECH Teaching Hospital Ogbomoso, Oyo State, Nigeria among children diagnosed with CM from February 2018 to September 2018. Fifty children with age range of 6 months to 12 years were included in the study. Outcome indicators were full recovery, alive with neurological sequelae and death. Nine of the identified clinical factors demonstrable on bedside were assigned score of 1 each and each score summated to form Bedside Prognostic Index (BPI). The median BPI Score ≥4 indicated fatal outcome. Receiver Operating Characteristic (ROC) curve validated the predictive ability of the BPI score on clinical outcomes. Chi-square test and student t-test were used for statistical analysis. Results: Out of total 50 children, 30 (60%) recovered fully, 11 (22%) participants had neurological deficit(s) and 9 (18%) participants died. The median BPI score among completely recovered, survived with neurological deficit(s) and died was 8, 6 and 4, respectively. BPI score ≥4 was an independent predictor of fatal outcome {Odd’s Ratio (OR)=7.875, p-value=0.013, Confidence Interval (CI)=1.547-40.091} with sensitivity and specificity of 80% and 76.67% respectively. The ROC of the predictive ability of BPI on clinical outcomes was 80.2%. Conclusion: Poor outcome was significantly associated with BPI of ≥4 in children with CM. The use of this scoring index should be encouraged to promptly manage children with CM at risk of poor outcome.

Keywords

• clinical predictive scores
• neurological sequelae determinants
• paediatric mortality trend