The development of a scoring system to assess the severity and complications of malaria

Abstract

A database of 144 malaria patients admitted to the General Hospitals of Colombo (GHC), Anuradhapura (GHA) and the Lady Ridgeway Childrens' Hospital in Colombo (LRH) during a period of 6 months from May 1994 was used to develop a numerical scoring system to assess severe and complicated malaria. The score was derived using 14 clinical criteria and scored for severity on a scale between 0-3 or 0-5. The total score was a summation of the individual scores for the 14 criteria. The clinical criteria, weightage given to each criterion and scale used were based on previous work on severe and complicated malaria and expert opinion. Each of the 144 subjects were given a score using the above method and independently categorised as to whether they had potentially life threatening malarial infection. The latter was defined as those warranting interventions (such as intravenous quinine therapy, blood transfusion and/or other intensive organ/system support), as judges by the attending doctor. The scoring system was then re-weighted to arrive at a discerning threshold score (of 6) above which the patient would be categorised as having severe and complicated malaria. We have thus developed a quantitative method to assess the degree of severity of severe and complicated malaria which takes into account moderate degrees of involvement in multiple organ/systems. This is a feature of severe malaria in Asia, unlike in Africa where severe pathology of a single organ/system is commoner.