Vital Sign alterations within 24 hours prior to death in children with retinopathy-positive Cerebral Malaria at Queen Elizabeth Central Hospital Malawi

Milcent Chintsanya¹, Charlotte Talham², Bo Zhang³, Terrie E. Taylor^4,5, Karl B. Seydel^4,5

1. School of Public Health and Family Medicine, Department of Family Medicine, Kamuzu University of Health Sciences, Blantyre, Malawi
2. Department of Biostatistics, University of Washington, Seattle, Washington
3. Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, Washington
4. Blantyre Malaria Project, Kamuzu University of Health Sciences, Blantyre, Malawi
5. Department of Osteopathic Medical Specialties, College of Osteopathic Medicine, Michigan State University, East Lansing, Michigan, USA

*Corresponding Author: Milcent Chintsanya; E-mail: mchintsanya@gmail.com

Abstract
Background
Malaria is a significant obstacle to child health and survival. Plasmodium falciparum infections, especially in children under five, lead to high morbidity and mortality. Cerebral malaria (CM) is a life-threatening complication characterized by coma, and its diagnosis can be improved by observing malarial retinopathy in children. Monitoring vital signs is essential for managing patients with CM.
Objectives
To determine if changes in vital signs predict death in children with retinopathy positive cerebral malaria (RPCM).
Methods
This was a retrospective case-control study using data collected from children admitted to the Paediatric Research Ward at Queen Elizabeth Central Hospital in Blantyre between 1997 and 2020. Patients who died 24 hours or more after admission were matched with control patients who survived. Linear regression analyses were used to assess the differential time trends of each vital sign in the survivor group and death group. Classification models were used to quantify various vital signs’ predictive power of death.
Results
Among the population that died, the estimated change in average respiratory rate per hour approaching death was 0.02 breaths per minute compared to -0.25 breaths per minute among those who survive (p < 0.001), and the estimated change in average BCS per hour approaching death was -0.01 compared to 0.06 among the survivors (p < 0.001). Changes in temperature and heart rate were not associated with clinical deterioration. Three models were developed, and the best receiver operating characteristic curve was 100% sensitive, the corresponding false positive rate was 75%.
Conclusion
Changes in respiratory rate and BCS have prognostic significance in the final 24 hours before death in children with cerebral malaria. Extra attention should be paid to these two vital signs as they may help to identify children who are at increased risk of deteriorating.