title: Prospective applicability study of the new dengue classification system for clinical management in children.
abstract: BACKGROUND
  To evaluate the efficacy of the 2009 revised dengue classification system proposed by the World Health Organization (WHO) for early detection of dengue cases requiring intervention.
  
  
  METHODS
  Children <15 years of age with dengue [confirmed by laboratory testing (IgM enzyme-linked immunosorbent assay, NS1 Ag or reverse transcriptase polymerase chain reaction) or by epidemiologic link] who were admitted to the Institute of Tropical Medicine during the 2011 dengue outbreak in Paraguay were prospectively included. Each case was classified according to the 1997 WHO dengue criteria and by the 2009 WHO revised criteria, which categorize dengue patients using a set of clinical finding into dengue with/without warning signs and severe dengue. The management of all cases followed the new recommendations.
  
  
  RESULTS
  During the 2011 dengue outbreak, 123 children were admitted with a mean age of 11 ± 3 years. By the 2009 classification system, 119 cases (97%) were classified as dengue requiring intervention [89 patients (75%) with warning signs and 30 patients (25%) with severe signs], whereas by the old system 67 patients (54%) were classified as dengue requiring intervention (P < 0.001). Further, by the 1997 classification, only 13 patients (10%) were classified as dengue hemorrhagic fever III/IV (severe cases), whereas with the 2009 classification 30 patients (24%) were considered as having severe dengue infection (P < 0.05) CONCLUSIONS:: This study confirms that the 2009 WHO dengue classification provides better detection of severe cases of dengue than the earlier 1997 WHO dengue system.
authors.affiliation: From the *Departamento de Pediatría, Institute of Tropical Medicine, Avda. Venezuela y Florida, Asunción; and †Universidad Nacional de Asunción, Barrio Villa Universitaria, San Lorenzo, Paraguay.
authors.forename: Dolores
authors.initials: D
authors.lastname: Lovera
authors.forename: Soraya
authors.initials: S
authors.lastname: Araya
authors.forename: Maria Jose
authors.initials: MJ
authors.lastname: Mesquita
authors.forename: Cinthia
authors.initials: C
authors.lastname: Avalos
authors.forename: Silvia
authors.initials: S
authors.lastname: Ledesma
authors.forename: Antonio
authors.initials: A
authors.lastname: Arbo
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004196:Disease Outbreaks; D005260:Female; D006801:Humans; D008297:Male; D010239:Paraguay / Q000453:epidemiology; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D019595:Severe Dengue / Q000145:classification* / Q000175:diagnosis / Q000453:epidemiology*; D012720:Severity of Illness Index; D014944:World Health Organization