Sensitivity and specificity of the World Health Organization dengue classification schemes for severe dengue assessment in children in Rio de Janeiro

The clinical definition of severe dengue fever remains a challenge for researchers in hyperendemic areas like Brazil. The ability of the traditional (1997) as well as the revised (2009) World Health Organization (WHO) dengue case classification schemes to detect severe dengue cases was evaluated in...

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Published in:PloS one 2014-04, Vol.9 (4), p.e96314-e96314
Main Authors: Macedo, Gleicy A, Gonin, Michelle Luiza C, Pone, Sheila M, Cruz, Oswaldo G, Nobre, Flávio F, Brasil, Patrícia
Format: Article
Language:English
Subjects:
Adolescent
Brazil - epidemiology
Child
Child, Preschool
Children
Classification
Classification schemes
Control
Critical Care - statistics & numerical data
Dengue
Dengue fever
Dengue hemorrhagic fever
Diagnostic tests
Distribution
Female
Fever
Health aspects
Hospitalization
Hospitals
Hospitals - statistics & numerical data
Humans
Infant
Infant, Newborn
Laboratories
Male
Medicine and Health Sciences
Patients
Pediatrics
Plasma
Public health
Reference Standards
Research and Analysis Methods
Sensitivity
Sensitivity and Specificity
Sepsis
Severe Dengue - classification
Severe Dengue - diagnosis
Severe Dengue - epidemiology
Therapeutic applications
Vector-borne diseases
Viral diseases
Working groups
World Health Organization
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description The clinical definition of severe dengue fever remains a challenge for researchers in hyperendemic areas like Brazil. The ability of the traditional (1997) as well as the revised (2009) World Health Organization (WHO) dengue case classification schemes to detect severe dengue cases was evaluated in 267 children admitted to hospital with laboratory-confirmed dengue. Using the traditional scheme, 28.5% of patients could not be assigned to any category, while the revised scheme categorized all patients. Intensive therapeutic interventions were used as the reference standard to evaluate the ability of both the traditional and revised schemes to detect severe dengue cases. Analyses of the classified cases (n = 183) demonstrated that the revised scheme had better sensitivity (86.8%, P
doi_str_mv 10.1371/journal.pone.0096314
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This improved sensitivity of the revised scheme allows for better case capture and increased ICU admission, which may aid pediatricians in avoiding deaths due to severe dengue among children, but, in turn, it may also result in the misclassification of the patients' condition as severe, reflected in the observed lower positive predictive value (61.6%, P&lt;0.001) when compared with the traditional scheme (82.6%, P&lt;0.001). The inclusion of unusual dengue manifestations in the revised scheme has not shifted the emphasis from the most important aspects of dengue disease and the major factors contributing to fatality in this study: shock with consequent organ dysfunction.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>24777054</pmid><doi>10.1371/journal.pone.0096314</doi><oa>free_for_read</oa></addata></record>
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subjects Adolescent
Brazil - epidemiology
Child
Child, Preschool
Children
Classification
Classification schemes
Control
Critical Care - statistics & numerical data
Dengue
Dengue fever
Dengue hemorrhagic fever
Diagnostic tests
Distribution
Female
Fever
Health aspects
Hospitalization
Hospitals
Hospitals - statistics & numerical data
Humans
Infant
Infant, Newborn
Laboratories
Male
Medicine and Health Sciences
Patients
Pediatrics
Plasma
Public health
Reference Standards
Research and Analysis Methods
Sensitivity
Sensitivity and Specificity
Sepsis
Severe Dengue - classification
Severe Dengue - diagnosis
Severe Dengue - epidemiology
Therapeutic applications
Vector-borne diseases
Viral diseases
Working groups
World Health Organization
title Sensitivity and specificity of the World Health Organization dengue classification schemes for severe dengue assessment in children in Rio de Janeiro
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