Dengue disease severity in Indonesian children: an evaluation of the World Health Organization classification system.
BACKGROUND
Dengue disease severity is usually classified using criteria set up by the World Health Organization (WHO). We aimed to assess the diagnostic accuracy of the WHO classification system and modifications to this system, and evaluated their potential practical usefulness.


METHODS
Patients, admitted consecutively to the hospital with severe dengue, were classified using the WHO classification system and modifications to this system. Treating physicians were asked to classify patients immediately after discharge. We calculated the sensitivity of the various classification systems for the detection of shock and the agreement between the various classification systems and the treating physician's classification.


RESULTS
Of 152 patients with confirmed dengue, sixty-six (43%) had evidence of circulatory failure. The WHO classification system had a sensitivity of 86% (95%CI 76-94) for the detection of patients with shock. All modifications to the WHO classification system had a higher sensitivity than the WHO classification system (sensitivity ranging from 88% to 99%). The WHO classification system was in only modest agreement with the intuitive classification by treating physicians whereas several modified classification systems were in good agreement.


CONCLUSIONS
The use of the WHO classification system to classify dengue disease severity is to be questioned, because it is not accurate in correctly classifying dengue disease severity and it lacks sufficient agreement with clinical practice.
Setiati
Tatty E
TE
Department of Child Health, Dr. Kariadi Hospital, Semarang, Indonesia. tatty@smg.melsa.net.id <tatty@smg.melsa.net.id>
Mairuhu
Albert T A
AT
Koraka
Penelopie
P
Supriatna
Mohamed
M
Mac Gillavry
Melvin R
MR
Brandjes
Dees P M
DP
Osterhaus
Albert D M E
AD
van der Meer
Jos W M
JW
van Gorp
Eric C M
EC
Soemantri
Augustinus
A
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003715:Dengue / Q000145:classification* / Q000150:complications / Q000175:diagnosis; D003716:Dengue Virus; D006801:Humans; D007214:Indonesia; D012720:Severity of Illness Index; D012769:Shock / Q000209:etiology; D014944:World Health Organization