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. 2019 Aug 20;13(8):e0007144.
doi: 10.1371/journal.pntd.0007144. eCollection 2019 Aug.

Assessment of the new World Health Organization's dengue classification for predicting severity of illness and level of healthcare required

Balgees A Ajlan  1 , Maram M Alafif  1 , Maha M Alawi  2   3 , Naeema A Akbar  4 , Eman K Aldigs  2 , Tariq A Madani  1   3
Affiliations

Assessment of the new World Health Organization's dengue classification for predicting severity of illness and level of healthcare required

Balgees A Ajlan et al. PLoS Negl Trop Dis. .

Abstract

The objective of this study was to assess the validity of the new dengue classification proposed by the World Health Organization (WHO) in 2009 and to develop pragmatic guidelines for case triage and management. This retrospective study involved 357 laboratory-confirmed cases of dengue infection diagnosed at King Abdulaziz University Hospital, Jeddah, Saudi Arabia over a 4-year period from 2014 to 2017. The sensitivity of the new classification for identifying severe cases was limited (65%) but higher than the old one (30%). It had a higher sensitivity for identifying patients who needed advanced healthcare compared to the old one (72% versus 32%, respectively). We propose adding decompensation of chronic diseases and thrombocytopenia-related bleeding to the category of severe dengue in the new classification. This modification improves sensitivity from 72% to 98% for identifying patients who need advanced healthcare without altering specificity (97%). It also improves sensitivity in predicting severe outcomes from 32% to 88%. In conclusion, the new classification had a low sensitivity for identifying patients needing advanced care and for predicting morbidity and mortality. We propose to include decompensation of chronic diseases and thrombocytopenia-related bleeding to the category of severe dengue in the new classification to improve the sensitivity of predicting cases requiring advanced care.

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Conflict of interest statement

The authors have declared that no competing interests exist.

References

    1. World Health Organization, Special Programme for Research and Training in Tropical Diseases Dengue: guidelines for diagnosis, treatment, prevention and control. World Health Organization; 2009. 147 p.
    1. Memish ZA, Albarrak A, Almazroa MA, Al-Omar I, Alhakeem R, Assiri A, et al. Seroprevalence of Alkhurma and Other Hemorrhagic Fever Viruses, Saudi Arabia. Emerg Infect Dis [Internet]. 2011. December;17(12):2316–8. Available from: http://wwwnc.cdc.gov/eid/article/17/12/11-0658_article.htm 10.3201/eid1712.110658 - DOI - PMC - PubMed
    1. Khan NA, Azhar EI, El-Fiky S, Madani HH, Abuljadial MA, Ashshi AM, et al. Clinical profile and outcome of hospitalized patients during first outbreak of dengue in Makkah, Saudi Arabia. Acta Trop [Internet]. 2008. January;105(1):39–44. Available from: http://linkinghub.elsevier.com/retrieve/pii/S0001706X07002288 10.1016/j.actatropica.2007.09.005 - DOI - PubMed
    1. Fakeeh M, Zaki AM. Virologic and serologic surveillance for dengue fever in Jeddah, Saudi Arabia, 1994–1999. Am J Trop Med Hyg [Internet]. 2001. December 1;65(6):764–7. Available from: 10.4269/ajtmh.2001.65.764 - DOI - PubMed
    1. Ayyub M, Khazindar AM, Lubbad EH, Barlas S, Alfi AY, Al-Ukayli S. Characteristics of dengue fever in a large public hospital, Jeddah, Saudi Arabia. J Ayub Med Coll Abbottabad. 2006;18(2):9–13. - PubMed

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