Hospitalization and ambulatory care in imported-malaria: evaluation of trends and impact on mortality. A prospective multicentric 14-year observational study

Malaria Journal

Research

Aurélie Etienne¹  France Mentré²  Sandrine Houzé³  Enrique Casalino⁴ 

[1] INSERM, IAME, UMR 1137, 75018, Paris, France;Service de Biostatistique, AP-HP, Hôpital Bichat, 75018, Paris, France;INSERM, IAME, UMR 1137, 75018, Paris, France;Service de Biostatistique, AP-HP, Hôpital Bichat, 75018, Paris, France;Université Paris Diderot, Sorbonne Paris Cité, 75018, Paris, France;Parasitology Laboratory, Centre National de Référence du Paludisme, Assistance Publique-Hôpitaux de Paris (AP-HP), University Hospital Bichat-Claude Bernard, Paris, France;RD UMR216, Mère et enfant face aux infections tropicales, 75006, Paris, France;Faculté des Sciences Pharmaceutiques et Biologiques, PRES Sorbonne Paris Cité, Université Paris Descartes, 75270, Paris, France;Service d’Accueil des Urgences, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Bichat-Claude Bernard, 46 rue Henri Huchard, 75018, Paris, France;Université Paris Diderot, PRES Sorbonne Paris Cité, EA 7334 «Recherche clinique coordonnée ville-hôpital, Méthodologies et Société (REMES)», Paris, France;

关键词: Imported malaria;    Hospitalization;    Ambulatory care;    Intensive care;    Mortality;   

DOI  :  10.1186/s12936-016-1364-9

 received in 2016-02-19, accepted in 2016-05-27,  发布年份 2016

来源: Springer

【 摘 要 】

BackgroundHospitalization is usually recommended for imported malaria. The goal of the present study is to evaluate the evolution in clinical pathways while measuring their impact on mortality.MethodsThis is a 14-year prospective observational study divided into three periods. We evaluated for adult (≥15 years) and paediatric (<15 years) case trends in severity, clinical pathways (hospitalization in medical ward (MW) or intensive care unit (ICU), ambulatory care) and mortality.ResultsIn total, 21,386 imported malaria cases were included, 4269 of them were paediatrics (20 %). Rises in severe forms for adults [from 8 % in period 1–14 % in period 3 (p = 0.0001)] and paediatrics [from 12 to 18 % (p < 0.0001)] were found. For adults, MW admission rates decreased [−15 % (CI 95 % −17; −13)] while ambulatory care [+7 % (CI 95 % 5–9)] and ICU admission rates [+4 % (CI 95 % 3–5)] increased. For paediatrics, increase in ICU admissions (+3 %) was shown. We did not observe any change in overall mortality during the study periods, whether among adults or children, regardless of care pathway.ConclusionsThe present study indicates a changing management of imported malaria in adults, with an increasing trend for ambulatory care. The absence of change in mortality for adults indicates that ambulatory care can be proposed for adults presenting non-severe imported malaria.

【 授权许可】

CC BY   
© The Author(s) 2016