Management of imported malaria in the emergency department: Adequacy compared to guidelines, and impact of the SARS-CoV-2 pandemic - 16/06/23
, A. Pitsch b, C. Cornaglia c, M. Picque b, A. de Pontfarcy a, P. Leroy a, T. Jault d, C. Thach e, M. Camus f, F. Dolveck c, S. Diamantis a
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Highlights |
• | What we already know on this topic: the risk factors for inappropriate management of imported malaria at the emergency departments (ED) are unknown. This lack of knowledge compromises the implementation of improvement strategies. |
• | What this study adds: inadequacy of malaria management is not due to organizational factors – except for the SARS-CoV-2 pandemic which resulted in a lower probability of adequate management, but rather to a perfectible knowledge of guidelines. |
• | Potential impact of this study on research, practice, or policy: increasing training of emergency physicians is key to improve imported malaria management at the ED. |
Abstract |
Objectives |
Adequacy of imported malaria management with respect to guidelines in emergency departments (ED) is low. We aimed to identify factors associated with this non-compliance, and a potential impact of the SARS-CoV-2 pandemic.
Patients and methods |
Patients presenting with imported malaria at the ED of the hospital of Melun (France), from January 1, 2017 to February 14, 2022 were retrospectively included.
Results |
Among 205 adults and 25 children, biological criteria of severity were fully assessed in 10% of cases; lactates (40%) and blood pH (21%) levels were the main missing variables. Of 74 patients (32%) with severe malaria, 13 were misclassified as uncomplicated malaria. The choice and dosage of treatment were adequate in 85% and 92% of cases, respectively. Treatment conformity was lower in severe malaria cases than in non-severe malaria cases (OR 0.15 [95% CI 0.07–0.31]), with oral treatment in 17 patients with severe malaria; conformity was higher in the intensive care unit (OR 4.10 [95% CI 1.21–13.95]). Patients with severe malaria were more likely to start treatment within 6hours than patients with uncomplicated malaria (OR 1.97 [95% CI 1.08–3.43]), as were patients infected by P.falciparum compared to other species (OR 4.63 [95% CI 1.03–20.90]). Consulting during the SARS-CoV-2 pandemic was the only organizational factor associated with a lower probability of adequate management (OR 0.42 [95% CI 0.23–0.75]).
Conclusion |
Initial evaluation of malaria severity and time to treatment administration could be improved. These have been adversely impacted by the SARS-CoV-2 pandemic.
Le texte complet de cet article est disponible en PDF.Keywords : Imported malaria, SARS-CoV-2, Guidelines
Plan
Vol 53 - N° 4
Article 104672- juin 2023 Retour au numéro
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