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)
| 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 Greater than 2 seconds.
2 Low JVP: < 3–4 cm above the sternal angle with the patient at 45º.
3 Very low JVP: invisible at rest with the patient at 45º, jugular vein fills with base of neck compression.
* In one patient the JVP was not visible and in one the capillary refill was not recorded.