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Coma scales for children with severe falciparum malaria

Coma scales for children with severe falciparum malaria
Coma scales for children with severe falciparum malaria

The Blantyre coma scale (BCS) is used to assess children with severe falciparum malaria, particularly as a criterion for cerebral malaria, but it has not been formally validated. We compared the BCS to the Adelaide coma scale (ACS), for Kenyan children with severe malaria. We examined the inter-observer agreement between 3 observers in the assessment of coma scales on 17 children by measuring the proportion of agreement (PA), disagreement rate (DR) and fixed sample size κ (κn). We assessed the sensivitity and specificity of the scales in detecting events (seizures and hypoglycaemia) in 240 children during admission and the usefulness of the scales in predicting outcome. There was considerable disagreement between observers in the assessment of both scales (BCS: PA = 0.55, DR = 0.09 and κn = 0.27; ACS: PA = O.36, DR = O.31, and κn = 0.31), particularly with the verbal component of the BCS (κn = 0.02). Compared to the ACS, the BCS was more specific (0.85 for BCS and 0.80 for ACS), but less sensitive (0.25-0.69 vs. 0.38-0.88 respectively) in detecting events and was a worse predictor of neurological sequelae. The BCS provided a better overall assessment of a child's incapacity from falciparum malaria, but the ACS was more useful in assessing neurological disturbances.

Adelaide coma scale, Blantyre coma scale, Children, Kenya, Malaria, Plasmodium falciparum
0035-9203
161-165
Newton, C.R.J.C.
4b076390-f30e-4cb0-85ac-b3dac80e9329
Chokwe, T.
d9ba6387-9b75-4295-ba0c-9f3eb7f83d95
Armstrong Schellenberg, J.
19edd640-69d2-4500-8ee8-bc79ea988c45
Winstanley, P.A.
755ebebb-a52e-45a4-bbd8-d903fa96f9cd
Forster, D.
26b31f4f-d384-4f4a-8d72-9d39da3cf146
Peshu, N.
5abe6b16-8d5d-4c0e-b81d-948659635b6f
Kirkham, F.J.
1dfbc0d5-aebe-4439-9fb2-dac6503bcd58
Marsh, K.
b2950be1-6a47-4677-ad56-bcfa8849f860
Newton, C.R.J.C.
4b076390-f30e-4cb0-85ac-b3dac80e9329
Chokwe, T.
d9ba6387-9b75-4295-ba0c-9f3eb7f83d95
Armstrong Schellenberg, J.
19edd640-69d2-4500-8ee8-bc79ea988c45
Winstanley, P.A.
755ebebb-a52e-45a4-bbd8-d903fa96f9cd
Forster, D.
26b31f4f-d384-4f4a-8d72-9d39da3cf146
Peshu, N.
5abe6b16-8d5d-4c0e-b81d-948659635b6f
Kirkham, F.J.
1dfbc0d5-aebe-4439-9fb2-dac6503bcd58
Marsh, K.
b2950be1-6a47-4677-ad56-bcfa8849f860

Newton, C.R.J.C., Chokwe, T., Armstrong Schellenberg, J., Winstanley, P.A., Forster, D., Peshu, N., Kirkham, F.J. and Marsh, K. (1997) Coma scales for children with severe falciparum malaria. Transactions of the Royal Society of Tropical Medicine and Hygiene, 91 (2), 161-165. (doi:10.1016/S0035-9203(97)90207-8).

Record type: Article

Abstract

The Blantyre coma scale (BCS) is used to assess children with severe falciparum malaria, particularly as a criterion for cerebral malaria, but it has not been formally validated. We compared the BCS to the Adelaide coma scale (ACS), for Kenyan children with severe malaria. We examined the inter-observer agreement between 3 observers in the assessment of coma scales on 17 children by measuring the proportion of agreement (PA), disagreement rate (DR) and fixed sample size κ (κn). We assessed the sensivitity and specificity of the scales in detecting events (seizures and hypoglycaemia) in 240 children during admission and the usefulness of the scales in predicting outcome. There was considerable disagreement between observers in the assessment of both scales (BCS: PA = 0.55, DR = 0.09 and κn = 0.27; ACS: PA = O.36, DR = O.31, and κn = 0.31), particularly with the verbal component of the BCS (κn = 0.02). Compared to the ACS, the BCS was more specific (0.85 for BCS and 0.80 for ACS), but less sensitive (0.25-0.69 vs. 0.38-0.88 respectively) in detecting events and was a worse predictor of neurological sequelae. The BCS provided a better overall assessment of a child's incapacity from falciparum malaria, but the ACS was more useful in assessing neurological disturbances.

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More information

Published date: 1 April 1997
Keywords: Adelaide coma scale, Blantyre coma scale, Children, Kenya, Malaria, Plasmodium falciparum

Identifiers

Local EPrints ID: 429797
URI: http://eprints.soton.ac.uk/id/eprint/429797
ISSN: 0035-9203
PURE UUID: b923df11-f2a4-41a5-aa8d-8faecb972c50
ORCID for F.J. Kirkham: ORCID iD orcid.org/0000-0002-2443-7958

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Date deposited: 05 Apr 2019 16:30
Last modified: 18 Mar 2024 02:54

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Contributors

Author: C.R.J.C. Newton
Author: T. Chokwe
Author: J. Armstrong Schellenberg
Author: P.A. Winstanley
Author: D. Forster
Author: N. Peshu
Author: F.J. Kirkham ORCID iD
Author: K. Marsh

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