Journal Article

Coma scales for children with severe falciparum malaria

C.R.J.C. Newton, T. Chokwe, J.Armstrong Schellenberg, P.A. Winstanley, D. Forster, N. Peshu, F.J. Kirkham and K. Marsh

in Transactions of The Royal Society of Tropical Medicine and Hygiene

Published on behalf of Royal Society of Tropical Medicine and Hygiene

Volume 91, issue 2, pages 161-165
Published in print April 1997 | ISSN: 0035-9203
Published online April 1997 | e-ISSN: 1878-3503 | DOI: https://dx.doi.org/10.1016/S0035-9203(97)90207-8
Coma scales for children with severe falciparum malaria

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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 interobserver 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 = 0·36, DR = 0·31, 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.

Keywords: malaria; Plasmodium falciparum; Adelaide coma scale; Blantyre coma scale; children; Kenya

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Subjects: Clinical Medicine ; Infectious Diseases ; Immunology ; Medical Microbiology and Virology ; Public Health and Epidemiology

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