Role of early warning signs in children with severe dengue infection

Authors

  • Sriram Pothapregada Department of Pediatrics, Indira Gandhi Medical College and Research Institute, Puducherry, India
  • Vijayalakshmi Sivapurapu Department of Critical Care and Anaesthesia, Indira Gandhi Medical College and Research Institute, Puducherry, India
  • Banupriya Kamalakannan Department of Pediatrics, Indira Gandhi Medical College and Research Institute, Puducherry, India
  • Mahalakshmy Thulasingham Department of community medicine, JIPMER, Puducherry, India

DOI:

https://doi.org/10.18203/2349-3291.ijcp20182540

Keywords:

Encephalopathy, Severe dengue, Warning signs, World Health Organization

Abstract

Background: The objective of the study was to evaluate and analyze the role of preceding early warning signs at admission in children with severe dengue infection.

Methods: All children (0-12 y of age) diagnosed and confirmed as dengue fever admitted at a tertiary care hospital at Puducherry were retrospectively analysed from hospital case records as per the revised World Health Organization(WHO) guidelines 2009 for dengue fever. The data was analysed by descriptive statistics using SPSS 16.0 statistical software. Early warning signs were analyzed by logistic regression and a P-value of <0.05 was taken as significant.

Results: Out of 360 children confirmed with diagnosis of dengue fever, non-severe and severe dengue infection was seen in 214(59.4%) and 146 cases (40.6%) respectively. The most common manifestation of severe dengue infection were shock (40.6%), bleeding (16.7%) and multiorgan failure (2.2%). On logistic regression, the warning signs most commonly associated with severe dengue infection were pain abdomen, hepatomegaly, hypotension at admission and HCT>20% with concomitant platelet<50,000/mm3. Clinical variables which were unlisted in the revised guidelines but significantly associated with severe dengue infection were Age >6 yrs, retro-orbital pain, palmar erythema, joint pain, splenomegaly, positive tourniquet test, right hypochondriac pain and epigastric tenderness.

Conclusions: Early identification of the preceding warning signs, timely intervention and vigilant monitoring can reduce the morbidity and mortality in children with severe dengue infection. Since there were other clinical variables not enlisted as warning signs but were significantly associated with severe dengue infection, the list of warning signs in the revised guidelines needs to be expanded.

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Published

2018-06-22

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Original Research Articles