Development of a Prognostic Prediction Model to Determine Severe Dengue in Children
To develop a prognostic prediction model using the seven warning signs highlighted by WHO revised Dengue fever classification 2009 to determine severe dengue in children.
In this prospective analytical study conducted in a tertiary care centre, consecutive sampling of all children aged 1mo to 12y admitted with serologically confirmed Dengue was done from May 2015 through August 2016. After excluding 27 patients with co-infections and co-morbidities, 359 patients were followed up daily to assess clinical and laboratory progression till discharge/ death. Independent predictors were abdominal pain or tenderness, persistent vomiting, lethargy, mucosal bleed, clinical fluid accumulation, hepatomegaly >2 cm and rising hematocrit concurrent with platelet count <100 × 109/L. Outcome measure was severe dengue defined as per WHO guidelines 2009.
Among 359 children, 93 progressed to severe dengue. In univariate analysis, significant predictors were clinical fluid accumulation (OR 4.773, p = 0.000, 95%CI 2.511–9.075), persistent vomiting (OR 1.944, p = 0.010, 95%CI 1.170–3.225), mucosal bleed (OR 2.045, p = 0.019, 95%CI 1.127–3.711) and hematocrit ≥0.40 concurrent with platelet count <100 × 109/L (OR 2.985, p = 0.000, 95%CI 1.783–4.997). The final multivariable model included clinical fluid accumulation (aOR 3.717, p = 0.000, 95%CI 1.901–7.269), hematocrit ≥0.40 concurrent with platelet count <100 × 109/L (aOR 2.252, p = 0.004, 95%CI 1.302–3.894) and persistent vomiting (p = 0.056) as predictors of severe dengue.
Among seven WHO warning signs, predictors of severe dengue as suggested by the present multivariable prediction model include clinical fluid accumulation, persistent vomiting and hematocrit ≥0.40 concurrent with platelet count <100 × 109/L.
KeywordsDengue fever Pediatric Prediction model Severe dengue WHO 2009 classification Warning signs
Abdominal Pain/ Tenderness
Aspartate Transaminase/ Alanine Transaminase
Clinical Fluid Accumulation
Disseminated Intravascular Coagulation/ Multi Organ Dysfunction Syndrome
Glasgow Coma Scale
Non Severe Dengue
Packed Cell Volume
Transparent Reporting of a Multivariable Prediction Model for Individual Prognosis or Diagnosis
- WHO TDR
World Health Organization- Tropical Diseases Research
The authors deeply acknowledge Kerala University of Health Sciences (KUHS) for granting permission for publication of this article, prepared as part of thesis work done in partial fulfilment of the requirements for Mphil (Clinical Epidemiology) degree course.
PS: Conceived the concept, designed the protocol, collected, analyzed & interpreted the data and prepared the manuscript; GS: Guided conduct of the study, critically revised & approved the manuscript; SK: Designed the study methodology, analyzed & interpreted the data and approved the version to be published. Dr. Santhoshkumar A, Professor & Head of Department of Pediatrics, Government Medical College, Thiruvananthapuram will act as guarantor for this paper.
Compliance with Ethical Standards
Conflict of Interest
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