title: Improvement in hospital indicators after changes in dengue case management in Nicaragua.
abstract: Dengue is a major problem worldwide, and improving case management is a significant priority. In consultation with colleagues in Thailand, changes in management of hospitalized dengue cases were introduced in Nicaragua, including oral rather than intravenous (IV) fluids upon admission, continuous monitoring of clinical and laboratory signs, and use of IV fluids principally during the critical phase and colloids in management of shock. Two periods were compared, before (2003) and after (2005) their implementation, to assess impact. In 2003, 182 hospitalized laboratory-confirmed dengue cases 0-14 years of age who presented < or = 5 days post-symptom onset were included in the study; 46 were enrolled in 2005. Outcomes included significant reductions in days of IV fluid administration ( P = 0.0001), number of patients receiving IV fluids ( P < 0.0001), and duration of hospitalization ( P < 0.0001), and a non-significant reduction in the number of admissions to the intensive care unit from 8 in 2003 to 0 in 2005 ( P = 0.36). This study demonstrates concrete gains in dengue patient care and case management.
authors.affiliation: Unidad de Infectología, Hospital Infantil Manuel del Jesús Rivera, Managua, Nicaragua.
authors.forename: Crisanta
authors.initials: C
authors.lastname: Rocha
authors.forename: Sheyla
authors.initials: S
authors.lastname: Silva
authors.forename: Aubree
authors.initials: A
authors.lastname: Gordon
authors.forename: Samantha N
authors.initials: SN
authors.lastname: Hammond
authors.forename: Douglas
authors.initials: D
authors.lastname: Elizondo
authors.forename: Angel
authors.initials: A
authors.lastname: Balmaseda
authors.forename: Eva
authors.initials: E
authors.lastname: Harris
mesh_terms: D000293:Adolescent; D019090:Case Management; D002648:Child; D002675:Child, Preschool; D003715:Dengue / Q000628:therapy*; D005260:Female; D005440:Fluid Therapy / Q000379:methods*; D006761:Hospitals / Q000592:standards*; D006801:Humans; D007223:Infant; D007902:Length of Stay; D008297:Male; D009527:Nicaragua; D012189:Retrospective Studies