title: Clinicians' diagnostic practice of dengue infections.
abstract: BACKGROUND
  Difficulties in the classification of dengue infection have been documented. Such difficulties could be due to the low awareness of the World Health Organization diagnostic guidelines among clinicians.
  
  
  OBJECTIVE
  To study the diagnostic practices of clinicians in classifying patients as dengue fever (DF) or dengue haemorrhagic fever (DHF)/dengue shock syndrome (DSS) at the time of discharge during an outbreak.
  
  
  METHODS
  A prospective descriptive study of clinical features and disease classification in adult and pediatric dengue patients in the University of Malaya Medical Centre.
  
  
  RESULTS
  Five hundred and twenty adult and 191 pediatric patients were enrolled. Thrombocytopenia and evidence of plasma leakage were present in 8% of adult and 19% of pediatric patients. Of these, 93% and 49%, respectively, were given the discharge diagnoses of DF instead of DHF/DSS. Hemoconcentration, serous effusion and thrombocytopenia were not recognized in clinicians' discharge diagnosis of DHF/DSS for adult patients. The receiver operating characteristic (ROC) curve suggested a lack of consistency in the use of WHO guidelines in establishing DHF/DSS in adult patients, while implying otherwise for pediatric patients.
  
  
  CONCLUSIONS
  DHF/DSS is an under-recognized condition by clinicians managing these patients. This can affect the case fatality rate of DHF/DSS and the economic burden of the disease. The lack of awareness in disease manifestations especially plasma leakage, can lead to delayed recognition of DHF/DSS.
authors.affiliation: Department of Applied Statistics, Faculty of Economics and Administration, University of Malaya, Malaysia. chrisng@um.edu.my
authors.forename: Chris Fook Sheng
authors.initials: CF
authors.lastname: Ng
authors.forename: Lucy Chai See
authors.initials: LC
authors.lastname: Lum
authors.forename: Noor Azina
authors.initials: NA
authors.lastname: Ismail
authors.forename: Lian Huat
authors.initials: LH
authors.lastname: Tan
authors.forename: Christina Phoay Lay
authors.initials: CP
authors.lastname: Tan
mesh_terms: D000046:Academic Medical Centers; D000293:Adolescent; D000328:Adult; D019540:Area Under Curve; D002648:Child; D002675:Child, Preschool; D003715:Dengue / Q000145:classification / Q000175:diagnosis* / Q000453:epidemiology* / Q000503:physiopathology; D004196:Disease Outbreaks; D006801:Humans; D008296:Malaysia / Q000453:epidemiology; D010818:Practice Patterns, Physicians'; D012372:ROC Curve; D019595:Severe Dengue / Q000145:classification / Q000175:diagnosis* / Q000453:epidemiology* / Q000503:physiopathology; D014944:World Health Organization