Repeated tourniquet testing as a diagnostic tool in dengue infection.
Prospective evaluation of repeated standard tourniquet testing as a diagnostic indicator of dengue infection was done. Included were patients admitted to a children's hospital in Kuala Lumpur on a clinical suspicion of dengue infection based on the World Health Organization (WHO) criteria. A standard method of tourniquet was performed on 79 patients on a daily basis following admission. subjects and negative in the remaining 14 subjects. Fifty-eight subjects were serologically confirmed cases, 4 indeterminate and the remaining 17 subjects had negative serology. For diagnostic classification, 13 had dengue fever, 49 with dengue haemmorhagic fever (DHF) while 17 had non-dengue infection. The sensitivity and specificity of the tourniquet test was 82.8% and 23.5% respectively. The positive predictive value (PPV) was 78.7% while the negative predictive value (NPV) was 28.6%. In addition, the tourniquet test aided in the diagnosis of one-fifth of patients with DHF, who presented with a positive tourniquet test as the only bleeding manifestation. It seems that in a hospital setting, the tourniquet test adds little to the diagnosis of dengue infection/DHF. A positive tourniquet test, repeatedly performed, was found clinically useful as a preliminary screening test in dengue infection as recommended by WHO. However, it was not very specific and had a high false positive rate.
Norlijah
O
O
Faculty of Medicine and Health Sciences, University Putra Malaysia, Kuala Lumpur, Malaysia.
Khamisah
A Nor
AN
Kamarul
A
A
Paeds
M
M
Mangalam
S
S
D002196:Capillaries / Q000503:physiopathology; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008296:Malaysia; D008297:Male; D010976:Platelet Count / Q000295:instrumentation; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D019595:Severe Dengue / Q000097:blood / Q000175:diagnosis* / Q000503:physiopathology; D013921:Thrombocytopenia / Q000209:etiology; D014111:Tourniquets