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Admission Point-of-Care Testing for the Clinical Care of Children with Cerebral Malaria
David Wichman1, Geoffrey Guenther2, Nthambose M Simango3
1School of Medicine and Health Sciences, The George Washington University, Washington, DC 20052, USA.
Insights
Point-of-care testing (PoCT) in critically ill children with cerebral malaria revealed frequent abnormal results. Abnormal PoCT values, particularly for glucose, potassium, and lactate, were linked to increased mortality risk.
Area of Science:
- Pediatric critical care
- Infectious diseases
- Clinical diagnostics
Background:
- Point-of-care testing (PoCT) offers an alternative to laboratory-based diagnostics, potentially improving care for critically ill children in resource-limited settings.
- Cerebral malaria (CM) is a severe complication of malaria, particularly affecting children in endemic regions.
- Effective management of CM requires timely and accurate laboratory monitoring.
Purpose of the Study:
- To evaluate the clinical utility of PoCT in managing critically ill children with CM in Malawi.
- To assess the frequency of abnormal PoCT results and associated clinical interventions.
- To determine the relationship between abnormal PoCT results and patient outcomes.
Main Methods:
- A prospective evaluation of 193 Malawian children with World Health Organization-defined CM from March 2019 to May 2023.
- Assessment of PoCT results for glucose, potassium, lactate, and creatinine.
- Analysis of clinical interventions in response to abnormal PoCT results and their association with patient outcomes.
Main Results:
- Over half (52.1%) of all PoCT results were abnormal.
- Clinical interventions were performed in 16.9% of children with abnormal results.
- Abnormal PoCT glucose (hypoglycemia), lactate (hyperlactatemia), and calcium (hypocalcemia) were associated with increased mortality risk.
Conclusions:
- PoCT provides valuable diagnostic information in critically ill children with CM in resource-limited settings.
- Abnormal PoCT results, especially for glucose, lactate, and calcium, indicate a higher risk of mortality.
- Further research is warranted to confirm if PoCT-guided interventions improve outcomes in pediatric CM.
Abstract:
Point-of-care testing (PoCT), an alternative to laboratory-based testing, may be useful in the clinical care of critically ill children in resource-limited settings. We evaluated the clinical utility of PoCT in the care of 193 Malawian children treated for World Health Organization-defined cerebral malaria (CM) between March 2019 and May 2023. We assessed the frequency of abnormal PoCT results and the clinical interventions performed in response to these abnormalities. We determined the association between abnormal PoCT results and patient outcomes. Overall, 52.1% of all PoCT results were abnormal. Of the children with abnormal results, clinical interventions occurred in 16.9%. Interventions most commonly followed abnormal results for PoCT glucose (100.0% of the patients had treatment for hypoglycemia), potassium (32.1%), lactate (22.0%), and creatinine (16.3%). Patients with hypoglycemia, hyperlactatemia, and hypocalcemia had a higher mortality risk than children with normal values. Future studies are needed to determine whether obtaining laboratory values using PoCT and the clinical response to these interventions modify outcomes in critically ill African children with CM.
