Evidence map›Paper›PMID 40736255›Full record

ArticleClinical infectious diseases : an official publication of the Infectious Diseases Society of America2025

Electroencephalogram Features Distinguish Cases of Cerebral Malaria Among Malawian Children With Fever and Coma.

Alexander Andrews, Dana B Harrar, Tesfaye Zelleke, Jiahui Zhang, Bo Zhang, John Barber, Rohini Dasan, Nathaniel Amoah, Olivia Findorff, Sean Krieger and 8 more

Erratum issuedAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

18 authors.

Alexander AndrewsDivision of Neurology, The George Washington University/Children's National Hospital, Washington D.C., USA.ORCID 0000-0002-2395-5147
Dana B HarrarDivision of Neurology, The George Washington University/Children's National Hospital, Washington D.C., USA.ORCID 0000-0001-6382-8479
Tesfaye ZellekeDivision of Neurology, The George Washington University/Children's National Hospital, Washington D.C., USA.
Jiahui ZhangDivision of Statistics, University of Washington, Seattle, Washington, USA.
Bo ZhangVaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, Washington, USA.ORCID 0000-0002-4381-1124
John BarberDivision of Biostatistics and Study Methodology, Children's National Research Institute, Washington D.C., USA.
Rohini DasanThe George Washington University, School of Medicine and Health Sciences, Washington D.C., USA.ORCID 0000-0002-9215-1628
Nathaniel AmoahThe George Washington University, School of Medicine and Health Sciences, Washington D.C., USA.
Olivia FindorffUniversity of Virginia, Charlottesville, Virginia, USA.
Sean KriegerCollege of Osteophatic Medicine, Michigan State University, East Lansing, Michigan, USA.
Emmalee BarrettThe George Washington University, School of Medicine and Health Sciences, Washington D.C., USA.
Nicole O'BrienBlantyre Malaria Project, Kamuzu University of Health Sciences/University of Malawi College of Medicine, Blantyre, Malawi.ORCID 0000-0002-8826-8671
Charlotte E FullerBlantyre Malaria Project, Kamuzu University of Health Sciences/University of Malawi College of Medicine, Blantyre, Malawi.ORCID 0009-0001-8745-8334
Christopher A MoxonBlantyre Malaria Project, Kamuzu University of Health Sciences/University of Malawi College of Medicine, Blantyre, Malawi.
Terrie E TaylorCollege of Osteophatic Medicine, Michigan State University, East Lansing, Michigan, USA.ORCID 0000-0001-7416-3986
Michael J GriffithsCentre for Child and Adolescent Health Research, Western Sydney (Baludarri) Precinct, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.
Stephen T J RayBlantyre Malaria Project, Kamuzu University of Health Sciences/University of Malawi College of Medicine, Blantyre, Malawi.
Douglas G PostelsDivision of Neurology, The George Washington University/Children's National Hospital, Washington D.C., USA.ORCID 0000-0001-5815-0691

Funding

Evaluating EEG as a diagnostic and prognostic biomarker in Malawian children with febrile comaR03NS124536 · NINDS · CHILDREN'S RESEARCH INSTITUTE · PI POSTELS, DOUGLAS · 2023 to 2024
$182k
NINDS NIH HHS R03 NS124536US National Institutes of Health R03NS124536
6 · The paper itself

Abstract

backgroundIn febrile comatose patients living in malaria-endemic areas, overlapping symptoms and limited laboratory capacity make it difficult to distinguish parasitic, bacterial, and viral central nervous system infections. We evaluated electroencephalography (EEG) as a biomarker to differentiate the microbiologic etiology of pediatric febrile coma at a major referral center in Malawi.

methodsThis was a retrospective case-control study comparing EEG recordings of Malawian children with cerebral malaria to those with febrile coma of nonmalarial cause (bacterial meningitis, viral encephalitis, or unknown cause). Participants were admitted to Queen Elizabeth Central Hospital (Blantyre, Malawi) between 2013 and 2021. Inclusion criteria were fever, coma (Blantyre Coma Score ≤2), and coma etiology (malarial or nonmalarial) defined by laboratory testing. Four supervised machine learning algorithms were used to train a balanced ensemble classifier, SuperLearner, generating test characteristics of the diagnostic ability of EEG features.

resultsTwo hundred three children with cerebral malaria and 87 children with nonmalarial coma were included. Univariate analysis of qualitative (visual) EEG interpretations revealed higher voltage, slower background frequency, more sleep elements, less variability, more abnormal organization, and less continuity in cerebral malaria. Quantitative waveform analysis showed greater power in cerebral malaria. Both quantitative and qualitative EEG interpretation distinguished coma etiology (area under the receiver operating characteristic curve [AUROC] = 0.85 and 0.86, respectively). Combining qualitative and quantitative interpretation methods, the test characteristic improved (AUROC = 0.90).

conclusionsEEG features distinguish malarial from nonmalarial coma in febrile Malawian children. This technology may aid in distinguishing the microbiologic etiology of febrile coma in malaria-endemic areas.

Indexed as

ComaElectroencephalographyFeverMalaria, CerebralCase-Control StudiesChildChild, PreschoolDiagnosis, DifferentialFemaleHumansInfantMachine LearningMalawiMaleRetrospective StudiesROC Curvecentral nervous systems infectioncerebral malariacomaelectroencephalography

Identifiers

PMID40736255
PMCPMC12596355

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.