The reliability of the physical examination to guide fluid therapy in adults with severe falciparum malaria: an observational study

Table 2 Ability of clinical signs to identify hypovolaemia in adults with severe malaria

Clinical finding	Hypovolaemic¹	Euvolaemic¹	PPV	NPV	Sensitivity	Specificity
			(95% CI)	(95% CI)	(95% CI)	(95% CI)
Dry mucous membranes	235/324	42/65	85%	21%	73%	35%
Dry mucous membranes	235/324	42/65	(80–89)	(14–29)	(68–78)	(24–48)
Dry axillae	138/324	27/65	84%	17%	43%	58%
Dry axillae	138/324	27/65	(77–89)	(12–23)	(37–48)	(46–71)
Decreased tissue turgor	12/324	7/65	63%	16%	4%	89%
Decreased tissue turgor	12/324	7/65	(38–84)	(12–20)	(2–6)	(79–96)
Prolonged capillary refill ^2,3	28/307	1/53	97%	16%	9%	98%
Prolonged capillary refill ^2,3	28/307	1/53	(82–100)	(12–20)	(6–13)	(90–100)
Tachycardia > 100 bpm³	127/308	16/53	89%	17%	41%	70%
Tachycardia > 100 bpm³	127/308	16/53	(82–93)	(12–23)	(36–47)	(56–82)
Tachycardia > 120 bpm³	28/308	2/53	93%	15%	9%	96%
Tachycardia > 120 bpm³	28/308	2/53	(78–99)	(12–20)	(6–13)	(87–100)
Low JVP⁴	101/303	18/64	85%	18%	33%	72%
Low JVP⁴	101/303	18/64	(77–91)	(14–24)	(28–39)	(59–82)

PPV Positive predictive value, NPV Negative predictive value.
¹ Hypovolaemic: global end diastolic volume index (GEDVI) <680 ml/m², euvolaemic: GEDVI: 680–800 ml/m².
² Greater than 2 seconds.
³ Excluding patients receiving inotropic support.
⁴ JVP < 3-4 cm above the sternal angle with the patient at 45º.

ISSN: 1475-2875