title: Safety and cost savings of reducing adult dengue hospitalization in a tertiary care hospital in Singapore.
abstract: BACKGROUND
  Previously, most dengue cases in Singapore were hospitalized despite low incidence of dengue hemorrhagic fever (DHF) or death. To minimize hospitalization, the Communicable Disease Centre at Tan Tock Seng Hospital (TTSH) in Singapore implemented new admission criteria which included clinical, laboratory, and DHF predictive parameters in 2007.
  
  
  METHODS
  All laboratory-confirmed dengue patients seen at TTSH during 2006-2008 were retrospectively reviewed for clinical data. Disease outcome and clinical parameters were compared over the 3 years.
  
  
  RESULTS
  There was a 33.0% mean decrease in inpatients after the new criteria were implemented compared with the period before (p < 0.001). The proportion of inpatients with DHF increased significantly from 31.7% in 2006 to 34.4% in 2008 (p = 0.008); 68 DHF cases were managed safely on an outpatient basis after compared with none before implementation. DHF inpatients had more serious signs such as clinical fluid accumulation (15.5% vs 2.9% of outpatients), while most DHF outpatients had hypoproteinemia (92.7% vs 81.3% of inpatients). The eight intensive care unit admissions and five deaths during this time period all occurred among inpatients. The new criteria resulted in a median cost saving of US$1.4 million to patients in 2008.
  
  
  CONCLUSIONS
  The new dengue admission criteria were effective in sustainably reducing length of hospitalization, yielding considerable cost savings. A minority of DHF patients with mild symptoms recovered uneventfully through outpatient management.
authors.affiliation: Tan Tock Seng Hospital, Communicable Disease Centre, 11 Jalan Tan Tock Seng, 308433 Singapore. linda_k_lee@ttsh.com.sg
authors.forename: Linda K
authors.initials: LK
authors.lastname: Lee
authors.forename: Arul
authors.initials: A
authors.lastname: Earnest
authors.forename: Luis R
authors.initials: LR
authors.lastname: Carrasco
authors.forename: Tun L
authors.initials: TL
authors.lastname: Thein
authors.forename: Victor C
authors.initials: VC
authors.lastname: Gan
authors.forename: Vernon J
authors.initials: VJ
authors.lastname: Lee
authors.forename: David C
authors.initials: DC
authors.lastname: Lye
authors.forename: Yee-Sin
authors.initials: YS
authors.lastname: Leo
mesh_terms: D000328:Adult; D015331:Cohort Studies; D003715:Dengue / Q000191:economics*; D005260:Female; D017048:Health Care Costs; D006760:Hospitalization / Q000191:economics* / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D010343:Patient Admission / Q000191:economics / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012846:Singapore; D062606:Tertiary Care Centers / Q000191:economics; D014218:Triage / Q000592:standards