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Higher Rates of Misdiagnosis in Pediatric Patients Versus Adults Hospitalized With Imported Malaria.
Pediatr Emerg Care. 2016 Apr; 32(4):227-231.PE

Abstract

OBJECTIVES

Despite the availability of effective antimalarial 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 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 Montefiore Medical Center 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 to 2012, 33 (35%) of them were children and 17 (18%) were with severe malaria. Most patients contracted malaria while visiting friends and relatives 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 Montefiore Medical Center 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 health care workers and raise awareness that friends and relatives may require more intensive pretravel counseling.

Authors+Show Affiliations

Albert Einstein College of Medicine, Bronx, NY.Montefiore Medical Center, Bronx, NY.Centers for Disease Control and Prevention, Atlanta, GA.Albert Einstein College of Medicine, Bronx, NY.

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

25322145

Citation

Goldman-Yassen, Adam E., et al. "Higher Rates of Misdiagnosis in Pediatric Patients Versus Adults Hospitalized With Imported Malaria." Pediatric Emergency Care, vol. 32, no. 4, 2016, pp. 227-231.
Goldman-Yassen AE, Mony VK, Arguin PM, et al. Higher Rates of Misdiagnosis in Pediatric Patients Versus Adults Hospitalized With Imported Malaria. Pediatr Emerg Care. 2016;32(4):227-231.
Goldman-Yassen, A. E., Mony, V. K., Arguin, P. M., & Daily, J. P. (2016). Higher Rates of Misdiagnosis in Pediatric Patients Versus Adults Hospitalized With Imported Malaria. Pediatric Emergency Care, 32(4), 227-231. https://doi.org/10.1097/PEC.0000000000000251
Goldman-Yassen AE, et al. Higher Rates of Misdiagnosis in Pediatric Patients Versus Adults Hospitalized With Imported Malaria. Pediatr Emerg Care. 2016;32(4):227-231. PubMed PMID: 25322145.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Higher Rates of Misdiagnosis in Pediatric Patients Versus Adults Hospitalized With Imported Malaria. AU - Goldman-Yassen,Adam E, AU - Mony,Vidya K, AU - Arguin,Paul M, AU - Daily,Johanna P, PY - 2014/10/17/entrez PY - 2014/10/17/pubmed PY - 2017/1/14/medline SP - 227 EP - 231 JF - Pediatric emergency care JO - Pediatr Emerg Care VL - 32 IS - 4 N2 - OBJECTIVES: Despite the availability of effective antimalarial 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 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 Montefiore Medical Center 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 to 2012, 33 (35%) of them were children and 17 (18%) were with severe malaria. Most patients contracted malaria while visiting friends and relatives 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 Montefiore Medical Center 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 health care workers and raise awareness that friends and relatives may require more intensive pretravel counseling. SN - 1535-1815 UR - https://www.unboundmedicine.com/medline/citation/25322145/full_citation L2 - http://dx.doi.org/10.1097/PEC.0000000000000251 DB - PRIME DP - Unbound Medicine ER -