Abstract
Objective The uncertainty of dengue's progression from infection to its severe form represents
a major health care challenge, especially in children. Clinical identification of
impending clinical manifestations of severe dengue (SD), along with proper and immediate
management, is crucial. Thus, this study assesses the ability of warning signs to
predict SD infection in pediatric patients.
Methods This cross-sectional study utilized purposive sampling using medical records from
January 2015 to December 2020. Children aged 0 to 18 years diagnosed with dengue fever
and SD according to the World Health Organization's 2009 criteria were included.
Discussion Multivariate analysis revealed that abdominal pain (odds ratio [OR]: 16.34; 95% confidence
interval [CI]: 3.78–70.64; p < 0.001), fluid accumulation (OR: 10.51, 95% CI: 1.17–94.3; p = 0.036), mucosal bleeding (OR: 4.77; 95% CI: 1.27–17.91; p = 0.021), lethargy (OR: 94.37; 95% CI: 4.92–180.79; p = 0.003), hepatomegaly (OR: 17.57; 95% CI: 2.14–144.13; p = 0.008), and increased hematocrit concurrent with a rapid decrease in platelets
(OR: 6.89; 95% CI: 1.79–26.51, p = 0.005) were associated with SD infection, with a high quality of discrimination
(area under the curve [AUC] = 0.96) and a high quality of fit (p = 0.73). Receiver operating characteristic analysis demonstrated that 1.5 warning
signs was the optimal cut-off for predicting SD infection, with a sensitivity of 90.9
and a specificity of 89.8%.
Conclusion All six warning signs were significantly associated with SD infection. The optimal
cut-off for predicting SD was 1.5 warning signs.
Keywords
dengue infection - severe dengue - warning signs - pediatrics
