COMA SCALES FOR CHILDREN WITH SEVERE FALCIPARUM-MALARIA

The Blantyre coma scale (BCS) is used to assess children with severe f alciparum malaria, particularly as a criterion for cerebral malaria, b ut it has not been formally validated. We compared the BCS to the Adel aide coma scale (ACS), for Kenyan children with severe malaria. We exa mined the inter-observer agreement between 3 observers in the assessme nt of coma scales on 17 children by measuring the proportion of agreem ent (PA), disagreement rate (DR) and fixed sample size kappa (kappa n) . We assessed the sensivitity and specificity of the scales in detecti ng events (seizures and hypoglycaemia) in 240 children during admissio n and the usefulness of the scales in predicting outcome. There was co nsiderable disagreement between observers in the assessment of both sc ales (BCS: PA=0.55, DR=0.09 and kappa n=0.27; ACS: PA=0.36, DR=0.31, a nd kappa n=0.31), particularly with the verbal component of the BCS (k appa n=0.02). Compared to the ACS, the BCS was more specific (0.85 for BCS and 0.80 for ACS), but less sensitive (0.25-0.69 vs. 0.38-0.88 re spectively) in detecting events and was a worse predictor of neurologi cal sequelae. The BCS provided a better overall assessment of a child' s incapacity from falciparum malaria, but the ACS was more useful in a ssessing neurological disturbances.