Table 1 Characteristics of patients with posturing
Clinical and laboratory characteristics, and changes during admission | Patients with no posturing (n = 254) | Patients posturing at admission (n = 85) | P value | Patients posturing after admission (n = 78) | P value |
|---|---|---|---|---|---|
Clinical characteristics on admission | |||||
Sex, male (%) | 130 (51.2) | 43 (50.6) | 0.93 | 42 (53.8) | 0.68 |
Mean (SD) age in months | 28.4(20.1) | 38.0(25.7) | 0.01 | 35.0 (21.0) | 0.01 |
Median (IQR) duration of illness in days | 2.0 (1 – 3) | 2.0 (1 – 3) | - | 2.0 (0.3 – 3) | - |
History of seizures, (%) | 217 (85.4) | 72 (85.7) | 0.95 | 66 (84.6) | 0.86 |
Median (IQR) duration of coma before admission in hrs | 3 (2 – 6) | 3 (2 – 6) | - | 4 (2 – 6) | - |
Mean (SD) axillary temperature °C | 38.0 (4.3) | 38.7 (7.0) | 0.25 | 38.8 (7.2) | 0.22 |
Deep (acidotic) breathing, (%) | 69 (27.2) | 26 (30.6) | 0.54 | 24 (30.8) | 0.54 |
Profound coma (BCS 0, (%)) | 58 (22.8) | 15 (17.6) | 0.31 | 19 (24.4) | 0.78 |
Retinal haemorrhages, (%) | 18 (7.1) | 15 (17.6) | 0.01 | 11 (14.1) | 0.07 |
Laboratory investigations on admission | |||||
Severe anaemia, (haemoglobin < 5.0 g/dl, (%)) | 54 (22.3) | 17 (20.5) | 0.73 | 14 (18.4) | 0.47 |
Hypoglycaemia, (Glucose < 2.2 mmol/L, (%)) | 51 (21.3) | 14 (17.7) | 0.50 | 17 (23.3) | 0.71 |
Severe acidosis, (Base excess < – 15, (%)) | 56 (24.6) | 19 (25.3) | 0.89 | 23 (32.9) | 0.17 |
Hyponatraemia, (Plasma sodium < 135 mmol/L, (%)) | 114 (47.7) | 39 (51.3) | 0.58 | 32 (43.8) | 0.56 |
Mean log10 (SD) of parasite density | 4.8 (1.2) | 4.8 (1.2) | 0.77 | 4.7 (1.3) | 0.39 |
Hyperparasitaemia, (> 20% parasitaemia, (%)) | 77 (31.8) | 22 (26.5) | 0.36 | 24 (31.6) | 0.97 |
Brainstem features of raised ICP observed during admission | |||||
Deterioration in level of consciousness, (%) | 64 (25.2) | 39 (45.9) | <0.01 | 43 (55.1) | <0.001 |
Sluggish pupillary reaction, (%) | 82 (32.4) | 37 (43.5) | 0.06 | 30 (38.5) | 0.32 |
Non-reactive pupils, (%) | 12 (4.7) | 3 (3.5) | 0.77* | 4 (5.1) | 1.00* |
Pupillary sizes, (%) | |||||
Constricted | 42 (16.5) | 6 (7.1) | 0.03 | 8 (10.3) | 0.18 |
Dilated | 41 (16.2) | 24 (28.6) | 0.01 | 19 (24.4) | 0.10 |
Unequal | 3 (1.2) | 3 (3.5) | 0.17* | 3 (3.8) | 0.14* |
Dysconjugate gaze, (%) | 42 (17.1) | 28 (33.3) | <0.01 | 20 (26.0) | 0.08 |
Congested retinal veins, blurred disc margins or overt papilloedema, (%) | 16 (6.3) | 14 (16.5) | <0.01 | 18 (23.1) | <0.001 |
Horizontal oculocephalic eye deviation, (%) | |||||
No deviation | 17 (6.7) | 5 (5.9) | 0.79 | 6 (7.7) | 0.76 |
Minimal deviation | 44 (17.3) | 16 (18.8) | 0.75 | 11 (14.1) | 0.50 |
Abnormalities in respiration, (%) | |||||
Irregular | 49 (19.3) | 18 (21.2) | 0.71 | 20 (25.6) | 0.23 |
Shallow | 42 (16.5) | 6 (7.1) | 0.03 | 14 (17.9) | 0.77 |
Respiratory arrest | 12 (4.7) | 9 (10.6) | 0.05 | 10 (12.8) | 0.01 |
Seizures | |||||
Clinical seizures witnessed in the ward, (%) | 29 (50.8) | 49 (57.6) | 0.27 | 58 (74.4) | <0.001 |
Type of witnessed seizures, (%) | |||||
Partial | 74 (29.1) | 28 (32.9) | 0.51 | 38 (48.7) | <0.01 |
Partial with secondary generalisation | 29 (11.4) | 11 (12.9) | 0.71 | 16 (20.5) | 0.04 |
Generalised | 81 (31.9) | 28 (32.9) | 0.86 | 39 (50.0) | <0.01 |
Outcome | |||||
Mortality, (%) | 32 (12.6) | 15 (17.6) | 0.24 | 16 (20.5) | 0.08 |
Neurological deficits, (%) | 17 (6.7) | 7 (8.2) | 0.63 | 15 (19.5) | <0.01 |