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

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

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%

(80–89)

(14–29)

(68–78)

(24–48)

Dry axillae

138/324

27/65

84%

17%

43%

58%

(77–89)

(12–23)

(37–48)

(46–71)

Decreased tissue turgor

12/324

7/65

63%

16%

4%

89%

(38–84)

(12–20)

(2–6)

(79–96)

Prolonged capillary refill 2,3

28/307

1/53

97%

16%

9%

98%

(82–100)

(12–20)

(6–13)

(90–100)

Tachycardia > 100 bpm3

127/308

16/53

89%

17%

41%

70%

(82–93)

(12–23)

(36–47)

(56–82)

Tachycardia > 120 bpm3

28/308

2/53

93%

15%

9%

96%

(78–99)

(12–20)

(6–13)

(87–100)

Low JVP4

101/303

18/64

85%

18%

33%

72%

(77–91)

(14–24)

(28–39)

(59–82)

  1. PPV Positive predictive value, NPV Negative predictive value.
  2. 1 Hypovolaemic: global end diastolic volume index (GEDVI) <680 ml/m2, euvolaemic: GEDVI: 680–800 ml/m2.
  3. 2 Greater than 2 seconds.
  4. 3 Excluding patients receiving inotropic support.
  5. 4 JVP < 3-4 cm above the sternal angle with the patient at 45º.