Value of physical examination in severe and complicated malaria

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Evans et al report a prospective study of 2446 children in Ghana with severe and complicated malaria who had systematic collection in a standardized format of clinical data and outcome. They found that capillary refill time (CRT) >2 seconds was an independent indicator of fatal outcome. Prolonged CRT, considered along with coma or respiratory disease, added sensitivity and specificity for need for lifesaving fluid or transfusion intervention. In resource-limited areas, this simple test could be implemented easily in order to triage management. In resource-rich areas, a careful physical examination also is valuable and should not be trumped by laboratory tests and monitoring devices. Prolonged CRT is a valuable indicator of tenuously compensated shock in patients whose blood pressure has not yet fallen.