title: An Evidence-Based Algorithm for Early Prognosis of Severe Dengue in the Outpatient Setting.
abstract: Early prediction of severe dengue could significantly assist patient triage and case management.
  
  
  
  We prospectively investigated 7563 children with ≤3 days of fever recruited in the outpatient departments of 6 hospitals in southern Vietnam between 2010 and 2013. The primary endpoint of interest was severe dengue (2009 World Health Organization Guidelines), and predefined risk variables were collected at the time of enrollment to enable prognostic model development.
  
  
  
  The analysis population comprised 7544 patients, of whom 2060 (27.3%) had laboratory-confirmed dengue; nested among these were 117 (1.5%) severe cases. In the multivariate logistic model, a history of vomiting, lower platelet count, elevated aspartate aminotransferase (AST) level, positivity in the nonstructural protein 1 (NS1) rapid test, and viremia magnitude were all independently associated with severe dengue. The final prognostic model (Early Severe Dengue Identifier [ESDI]) included history of vomiting, platelet count, AST level. and NS1 rapid test status.
  
  
  
  The ESDI had acceptable performance features (area under the curve = 0.95, sensitivity 87% (95% confidence interval [CI], 80%-92%), specificity 88% (95% CI, 87%-89%), positive predictive value 10% (95% CI, 9%-12%), and negative predictive value of 99% (95% CI, 98%-100%) in the population of all 7563 enrolled children. A score chart, for routine clinical use, was derived from the prognostic model and could improve triage and management of children presenting with fever in dengue-endemic areas.
authors.affiliation: Children's Hospital No. 1, Ho Chi Minh City, Vietnam
authors.forename: Minh Tuan
authors.initials: MT
authors.lastname: Nguyen
authors.affiliation: Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Oxford, England, UK.
authors.forename: Thi Nhan
authors.initials: TN
authors.lastname: Ho
authors.affiliation: Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Oxford, England, UK.
authors.forename: Van Vinh Chau
authors.initials: VV
authors.lastname: Nguyen
authors.affiliation: Children's Hospital No. 1, Ho Chi Minh City, Vietnam
authors.forename: Thanh Hung
authors.initials: TH
authors.lastname: Nguyen
authors.affiliation: Children's Hospital No. 2, Ho Chi Minh City, Vietnam
authors.forename: Manh Tuan
authors.initials: MT
authors.lastname: Ha
authors.affiliation: Tien Giang Provincial Hospital, My Tho, Vietnam.
authors.forename: Van Tram
authors.initials: VT
authors.lastname: Ta
authors.affiliation: Dong Nai Children's Hospital, Bien Hoa, Vietnam.
authors.forename: Le Da Ha
authors.initials: LD
authors.lastname: Nguyen
authors.affiliation: Long An Provincial Hospital, Tan An, Vietnam.
authors.forename: Loi
authors.initials: L
authors.lastname: Phan
authors.affiliation: Binh Duong Provincial Hospital, Thu Dau Mot, Vietnam.
authors.forename: Khoi Quang
authors.initials: KQ
authors.lastname: Han
authors.affiliation: Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Oxford, England, UK.
authors.forename: Thi Hue Kien
authors.initials: TH
authors.lastname: Duong
authors.affiliation: Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Oxford, England, UK.
authors.forename: Nguyen Bich Chau
authors.initials: NB
authors.lastname: Tran
authors.affiliation: Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Oxford, England, UK.|Centre for Tropical Medicine, Nuffield Department of Medicine, University of Oxford, United Kingdom
authors.forename: Bridget
authors.initials: B
authors.lastname: Wills
authors.affiliation: Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Oxford, England, UK.|Centre for Tropical Medicine, Nuffield Department of Medicine, University of Oxford, United Kingdom
authors.forename: Marcel
authors.initials: M
authors.lastname: Wolbers
authors.affiliation: Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Oxford, England, UK.|Centre for Tropical Medicine, Nuffield Department of Medicine, University of Oxford, United Kingdom|Department of Microbiology and Immunology, Peter Doherty Institute for Infection and Immunity, University of Melbourne, Victoria, Australia.
authors.forename: Cameron P
authors.initials: CP
authors.lastname: Simmons
mesh_terms: D000465:Algorithms; D015415:Biomarkers; D002648:Child; D002675:Child, Preschool; D003716:Dengue Virus / Q000145:classification / Q000235:genetics; D005260:Female; D006801:Humans; D008297:Male; D049451:Nomograms; D016017:Odds Ratio; D010045:Outpatients; D011159:Population Surveillance; D011379:Prognosis; D011446:Prospective Studies; D012372:ROC Curve; D019595:Severe Dengue / Q000175:diagnosis* / Q000453:epidemiology* / Q000821:virology; D063189:Symptom Assessment; D013997:Time Factors; D014744:Vietnam / Q000453:epidemiology
chemical_list: D015415:Biomarkers
keywords: dengue; diagnosis; tropical infectious diseases.