title: Use of Warning Signs for Dengue by Pediatric Health Care Staff in Brazil.
abstract: OBJECTIVE
  The aim of this study was to describe the use of dengue warning signs by pediatric healthcare staff in the Brazilian public health care system.
  
  
  METHODS
  Cross-sectional study (2012) with physicians, nurses, and nurse technicians assisting children in five health care facilities. Participants reported the use and importance of dengue warning signs in pediatrics clinical practice through a structured questionnaire. Differences in the use of signs (chi-square test) and in the ranking assigned to each of them (Kruskal-Wallis) were assessed according to health care occupation and level of care (p<0.05).
  
  
  RESULTS
  The final sample comprised 474 participants (97%), mean age of 37 years (standard deviation = 10.3), mainly females (83.8%), physicians (40.1%) and from tertiary care (75.1%). The majority (91%) reported using warning signs for dengue in pediatrics clinical practice. The most widely used and highly valued signs were major hemorrhages (gastrointestinal, urinary), abdominal pain, and increase in hematocrit concurrent or not with rapid decrease in platelet count. Persistent vomiting as well as other signs of plasma leakage such as respiratory distress and lethargy/restlessness were not identified as having the same degree of importance, especially by nurse technicians and in primary or secondary care.
  
  
  CONCLUSIONS
  Although most health care staff reported using dengue warning signs, it would be useful to extend the training for identifying easily recognizable signs of plasma leakage that occur regardless of bleeding.
authors.affiliation: Department of Pediatrics, Rio de Janeiro State University, Rio de Janeiro, RJ, Brazil.|School of Medicine, Estácio de Sá University, Rio de Janeiro, RJ, Brazil.
authors.forename: Luana
authors.identifier: http://orcid.org/0000-0001-8412-7735
authors.initials: L
authors.lastname: Sicuro Correa
authors.affiliation: Laboratory of Clinical Epidemiology, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil.|School of Medicine, Estácio de Sá University, Rio de Janeiro, RJ, Brazil.
authors.forename: Yara Hahr Marques
authors.initials: YH
authors.lastname: Hökerberg
authors.affiliation: Laboratory of Clinical Epidemiology, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil.
authors.forename: Raquel de Vasconcellos Carvalhaes de
authors.initials: RV
authors.lastname: Oliveira
authors.affiliation: Department of Pediatrics, Rio de Janeiro State University, Rio de Janeiro, RJ, Brazil.
authors.forename: Danielle Martins de Souza
authors.initials: DM
authors.lastname: Barros
authors.affiliation: Department of Obstetrics and Gynecology, Rio de Janeiro State University, Rio de Janeiro, RJ, Brazil.
authors.forename: Helenara Abadia Ferreira
authors.initials: HA
authors.lastname: Alexandria
authors.affiliation: Germano Sinval Faria Teaching Primary Care Center, National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brasil.
authors.forename: Regina Paiva
authors.initials: RP
authors.lastname: Daumas
authors.affiliation: Laboratory of Clinical Epidemiology, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil.
authors.forename: Carlos Augusto Ferreira de
authors.initials: CA
authors.lastname: Andrade
authors.affiliation: Laboratory of Clinical Epidemiology, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil.
authors.forename: Sonia Regina Lambert
authors.initials: SR
authors.lastname: Passos
authors.affiliation: Acute Febrile Illnesses Laboratory, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil.
authors.forename: Patrícia
authors.initials: P
authors.lastname: Brasil
mesh_terms: D000328:Adult; D001938:Brazil; D003430:Cross-Sectional Studies; D003695:Delivery of Health Care; D003715:Dengue / Q000175:diagnosis*; D005260:Female; D006282:Health Personnel; D006801:Humans; D008297:Male; D010372:Pediatrics; D011795:Surveys and Questionnaires; D014839:Vomiting / Q000175:diagnosis