title: Tourniquet Test for Dengue Diagnosis: Systematic Review and Meta-analysis of Diagnostic Test Accuracy.
abstract: BACKGROUND
  Dengue fever is a ubiquitous arboviral infection in tropical and sub-tropical regions, whose incidence has increased over recent decades. In the absence of a rapid point of care test, the clinical diagnosis of dengue is complex. The World Health Organisation has outlined diagnostic criteria for making the diagnosis of dengue infection, which includes the use of the tourniquet test (TT).
  
  
  OBJECTIVE
  To assess the quality of the evidence supporting the use of the TT and perform a diagnostic accuracy meta-analysis comparing the TT to antibody response measured by ELISA.
  
  
  METHODS
  A comprehensive literature search was conducted in the following databases to April, 2016: MEDLINE (PubMed), EMBASE, Cochrane Central Register of Controlled Trials, BIOSIS, Web of Science, SCOPUS.
  
  
  METHODS
  Studies comparing the diagnostic accuracy of the tourniquet test with ELISA for the diagnosis of dengue were included.
  
  
  METHODS
  Two independent authors extracted data using a standardized form.
  
  
  RESULTS
  A total of 16 studies with 28,739 participants were included in the meta-analysis. Pooled sensitivity for dengue diagnosis by TT was 58% (95% Confidence Interval (CI), 43%-71%) and the specificity was 71% (95% CI, 60%-80%). In the subgroup analysis sensitivity for non-severe dengue diagnosis was 55% (95% CI, 52%-59%) and the specificity was 63% (95% CI, 60%-66%), whilst sensitivity for dengue hemorrhagic fever diagnosis was 62% (95% CI, 53%-71%) and the specificity was 60% (95% CI, 48%-70%). Receiver-operator characteristics demonstrated a test accuracy (AUC) of 0.70 (95% CI, 0.66-0.74).
  
  
  CONCLUSIONS
  The tourniquet test is widely used in resource poor settings despite currently available evidence demonstrating only a marginal benefit in making a diagnosis of dengue infection alone.
  
  
  BACKGROUND
  The protocol for this systematic review was registered at
  CRD42015020323.
authors.affiliation: Universidade do Extremo Sul Catarinense, Criciuma, SC, Brazil.|Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom.
authors.forename: Antonio Jose
authors.identifier: http://orcid.org/0000-0001-7182-075X
authors.initials: AJ
authors.lastname: Grande
authors.affiliation: Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom.
authors.forename: Hamish
authors.initials: H
authors.lastname: Reid
authors.affiliation: Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom.
authors.forename: Emma
authors.initials: E
authors.lastname: Thomas
authors.affiliation: Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom.|British Heart Foundation Centre on Population Approaches for Non-Communicable Disease Prevention, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom.
authors.forename: Charlie
authors.initials: C
authors.lastname: Foster
authors.affiliation: Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom.|Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam.
authors.forename: Thomas C
authors.initials: TC
authors.lastname: Darton
mesh_terms: D003715:Dengue / Q000175:diagnosis*; D003937:Diagnosis, Differential; D004797:Enzyme-Linked Immunosorbent Assay / Q000379:methods*; D006801:Humans; D012680:Sensitivity and Specificity; D014111:Tourniquets