Higher Rates of Misdiagnosis in Pediatric Patients versus Adults Hospitalized with Imported Malaria

Details

• Alternative Title:
  Pediatr Emerg Care
• Personal Author:
  Goldman-Yassen, Adam E. ; Mony, Vidya K. ; Arguin, Paul M. ; Daily, Johanna P.
• Description:
  Objectives
  
  Despite the availability of effective anti-malarial prophylaxis, imported adult and pediatric malaria occurs in the United States and this can pose diagnostic issues. We examined the clinical characteristics and diagnostic challenges of imported malaria requiring adult or pediatric inpatient admission at Montefiore Medical Center (MMC) in the Bronx which provides care for a large population of immigrants from malaria endemic areas.
  
  Study Design
  
  We conducted a retrospective single center review of patients admitted with a diagnosis of malaria at MMC from 2005 through 2012. We extracted historical, clinical, and laboratory values from the electronic medical record and patient charts.
  
  Results
  
  We identified 95 patients who were diagnosed and hospitalized with malaria from 2005–2012, 33 (35%) of them children and 17 (18%) with severe malaria. Most patients contracted malaria while visiting friends and relatives (VFR) in West Africa. Only 38% of travelers took prophylaxis, and fewer than half reported taking it as prescribed. Misdiagnosis by emergency room or primary care doctors was observed in almost one quarter of all of the patients. Misdiagnosis occurred significantly more frequently in children (43%) compared to adults (13%) (p=0.002). Pediatric patients were more likely to present with abdominal pain (42% vs 15%, p=0.005).
  
  Conclusions
  
  Pediatric patients admitted for imported malaria at MMC had a higher rate of misdiagnosis and presented with more gastrointestinal symptoms than hospitalized adults. By describing the clinical characteristics of patients with imported malaria, we hope to improve diagnostic accuracy by healthcare workers and raise awareness that VFRs may require more intensive pre-travel counseling.
  
  
• Subjects:
  Adult Antimalarials Child Child, Preschool Cross-Sectional Studies Diagnostic Errors Emergency Service, Hospital Emigrants And Immigrants Female Hospitalization Humans Malaria Male Pediatrics Plasmodium Retrospective Studies Travel

  More +
• Source:
  Pediatr Emerg Care. 32(4):227-231.
• Pubmed ID:
  25322145
• Pubmed Central ID:
  PMC4627851
• Document Type:
  Journal Article
• Funding:
  CC999999/Intramural CDC HHS/United States
• Place as Subject:
  United States
• Volume:
  32
• Issue:
  4
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:d27a145756905cc987b2b7e5c306aa986bf676306c24b93d4983c714c93cb9fa
• Download URL:
  https://stacks.cdc.gov/view/cdc/36354/cdc_36354_DS1.pdf
• File Type:
  [PDF - 234.59 KB ]