Clinical Impact of Malaria Rapid Diagnostic Testing at a US Children's Hospital.

TitleClinical Impact of Malaria Rapid Diagnostic Testing at a US Children's Hospital.
Publication TypeJournal Article
Year of Publication2019
AuthorsEnane LA, Sullivan KV, Spyridakis E, Feemster KA
JournalJ Pediatric Infect Dis Soc
Date Published2019 Apr 16
ISSN2048-7207
Abstract

BACKGROUND: Children who develop malaria after returning to a setting in which the disease is not endemic are at high risk for critical delays in diagnosis and initiation of antimalarial therapy. We assessed the clinical impact of the implementation of malaria rapid diagnostic testing (RDT) on the management of children with malaria at an urban US children's hospital that serves a large immigrant population.

METHODS: This was a retrospective cohort study of all children diagnosed with laboratory-confirmed malaria at the Children's Hospital of Philadelphia (CHOP) between 2000 and 2014. RDT using a US Food and Drug Administration-approved immunochromatographic assay was introduced at CHOP on August 1, 2007. We compared clinical management and outcomes of patients with malaria diagnosed before and after RDT introduction.

RESULTS: We analyzed 82 pediatric malaria cases (32 before and 50 after RDT implementation). The majority of these patients had traveled to West Africa (91.5%) and were infected with Plasmodium falciparum (80.5%). The mean time to a positive result decreased from 10.4 to 0.9 hours (P < .001) after the introduction of RDT for patients with P falciparum. The mean time to antimalarial therapy decreased from 13.1 to 6.9 hours (P =; .023) in hospitalized patients. We found no significant reduction in the mean number of clinical signs of severe malaria between 0 and 48 hours of hospitalization and no difference in the need for exchange transfusion, time to resolution of parasitemia, or length of hospital stay.

CONCLUSIONS: Implementation of RDT for malaria was associated with shorter times to malaria diagnosis and initiation of antimalarial therapy. The results of this study support RDT in the optimal management of patients with malaria who present in settings in which the disease is not endemic.

DOI10.1093/jpids/piz022
Alternate JournalJ Pediatric Infect Dis Soc
PubMed ID30989220