title: The impact of a program for strengthening dengue hemorrhagic fever case management on the clinical outcome of dengue hemorrhagic fever patients.
abstract: This study compared the case fatality ratio (CFR) of dengue shock syndrome (DSS) patients admitted to Buri Ram Hospital, an area with CFR of 0.11, 0.43 and 0.23% in 2002, 2003 and 2004, respectively, to obtain a provincial model for dengue case management using the I. development of a special program for strengthening dengue hemorrhagic fever (DHF) case management (No deaths in DSS patients), II. a retrospective review of the medical records of dengue fever (DF), DHF and DSS patients referred to Buri Ram Hospital. We compared the data during the 3 periods of the implementation of this program. Data was statistically analyzed using chi2 or Fisher's exact test for categorical variables, one-way ANOVA for continuous data with normal distribution and Kruskal-Wallis test for nonparametric variables. The numbers of DF, DHF and DSS cases in Buri Ram were 1332, 1700 and 1630 person, respectively, during 2006-2008. The number of DSS patients increased after implementation of the program: 12.2, 51.2 and 47.22 for 2006, 2007 and 2008, respectively, but the complications of the disease decreased. The CFR during 2006, 2007 and 2008 were 0.15, 0 and 0.06% (p > 0.05). The program for strengthening DHF case management did improve clinical outcomes in dengue patients after the implementation. The CFR in 2008 was only 0.06%, lower than the goal of the Ministry of Public Health (<0.13%). This program is still running, sustaining low CFR in dengue patients. It may be used as a model for other provinces in Thailand that have high dengue deaths.
authors.affiliation: Pediatric Department, Buri Ram Hospital, Thailand. jum_mu07@hotmail.com
authors.forename: Saengdao
authors.initials: S
authors.lastname: Mayurasakorn
authors.forename: Nipar
authors.initials: N
authors.lastname: Suttipun
mesh_terms: D000293:Adolescent; D019090:Case Management / Q000592:standards*; D002648:Child; D019091:Critical Pathways; D003430:Cross-Sectional Studies; D006292:Health Priorities; D006801:Humans; D007297:Inpatients; D007318:Inservice Training; D008297:Male; D008485:Medical Audit; D017063:Outcome Assessment, Health Care; D017410:Practice Guidelines as Topic; D012017:Referral and Consultation; D012189:Retrospective Studies; D019595:Severe Dengue / Q000401:mortality* / Q000628:therapy*; D013785:Thailand / Q000453:epidemiology