Retrospective study of imported falciparum malaria in French paediatric intensive care units

Objective The World Health Organization (WHO) severity criteria for paediatric Plasmodium falciparum (Pf) malaria are based on studies in countries of endemic malaria. The relevance of these criteria for other countries remains unclear. We assessed the relevance of these criteria in an industrialised country. Design Retrospective case-control study. Setting Eight French university hospitals, from 2006 to 2012. Patients Children with Pf malaria admitted to paediatric intensive care units (cases: n=55) or paediatric emergency departments (controls: n=110). Main outcome measures Descriptive analysis of WHO severity criteria and major interventions (mechanical ventilation, blood transfusion, fluid challenge, treatment of cerebral oedema, renal replacement therapy). Thresholds were set by receiver operating characteristics curve analysis. Results Altered consciousness (71% vs 5%), shock (24% vs 1%), renal failure (20% vs 1%), anaemia 50 µmol/L (25% vs 8%) and parasitaemia >10% (30% vs 8%) were more frequent in cases (p 3 (46% vs 7%) and anaemia (haemoglobin concentration Conclusions The WHO severity criteria for paediatric Pf malaria are relevant for countries without endemic malaria. The infrequent but severe complications also provide a timely reminder of the morbidity and mortality associated with this condition worldwide. In non-endemic countries haemoglobin 3 could be used as additional criteria to identify children needing high level of care.