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Table 4 Ability of clinical signs to identify volume responsiveness in adults with severe malaria (Includes only those patients receiving a fluid bolus of >500 ml in the absence of inotropic support)

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

Clinical finding Volume responsive Not volume responsive PPV NPV Sensitivity Specificity
(95% CI) (95% CI) (95% CI) (95% CI)
Dry mucous membranes 19/23 44/58 30% (19–43) 78% (52–94) 83% (61–95) 24% (14–37)
Dry axillae 9/23 29/58 24% (11–40) 67% (51–81) 39% (20–61) 50% (37–63)
Decreased tissue turgor 2/23 2/58 50% (7–93) 73% (61–82) 9% (1–28) 97% (88–100)
Prolonged capillary refill 1* 4/23 12/57 25% (7–52) 70% (58–81) 17% (5–39) 79% (66–89)
Tachycardia > 100 bpm 11/23 29/58 28% (15–44) 71% (54–84) 48% (27–69) 50% (37–63)
Tachycardia > 120 bpm 0/23 3/58 0% (0–77) 71% (59–80) 0% (0–15) 95% (86–99)
Low JVP2* 11/23 15/57 42% (23–63) 78% (64–88) 48% (27–69) 74% (60–85)
Very low JVP3* 6/23 9/57 40% (16–68) 74% (61–84) 26% (10–48) 84% (72–93)
  1. 1 Greater than 2 seconds.
  2. 2 Low JVP: < 3–4 cm above the sternal angle with the patient at 45º.
  3. 3 Very low JVP: invisible at rest with the patient at 45º, jugular vein fills with base of neck compression.
  4. * In one patient the JVP was not visible and in one the capillary refill was not recorded.