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Updated: Feb 15, 2026
Protocol for Dengue Infections in Mosquitoes A. aegypti and Infection Phenotype Determination
Published on: July 4, 2007
Development of a Prognostic Prediction Model to Determine Severe Dengue in Children
Priya Sreenivasan1, Geetha S2,3, Sasikala K3
1Department of Pediatrics, Government Medical College, Thiruvananthapuram, Thiruvananthapuram District, Kerala, 695011, India. priyavineed16@gmail.com.
Insights
This study identifies key warning signs for severe dengue in children. Clinical fluid accumulation, persistent vomiting, and rising hematocrit with low platelets are crucial predictors of severe dengue.
Area of Science:
- Pediatrics
- Infectious Diseases
- Epidemiology
Background:
- Dengue fever is a significant global health concern, particularly in pediatric populations.
- Accurate prediction of severe dengue is crucial for timely intervention and improved patient outcomes.
- The World Health Organization (WHO) revised Dengue classification in 2009, highlighting seven warning signs.
Purpose of the Study:
- To develop and validate a prognostic prediction model for severe dengue in children.
- To identify independent predictors of severe dengue among the WHO-defined warning signs.
- To enhance early detection and management strategies for severe dengue in pediatric cases.
Main Methods:
- A prospective analytical study was conducted on 359 children (1 month to 12 years) admitted with confirmed dengue.
- Patients were monitored daily for clinical and laboratory progression, excluding those with co-infections or co-morbidities.
- A multivariable prediction model was developed using logistic regression to identify independent predictors of severe dengue.
Main Results:
- Out of 359 children, 93 progressed to severe dengue.
- Key predictors identified in the multivariable model were clinical fluid accumulation (aOR 3.717), rising hematocrit with platelet count <100×10⁹/L (aOR 2.252), and persistent vomiting (p=0.056).
- Clinical fluid accumulation, persistent vomiting, and hematocrit ≥0.40 concurrent with platelet count <100×10⁹/L were significant predictors.
Conclusions:
- The study successfully developed a prognostic model for severe dengue in children using WHO warning signs.
- Clinical fluid accumulation, persistent vomiting, and specific hematocrit/platelet levels are critical indicators for predicting severe dengue.
- These findings can aid clinicians in early identification and management of severe dengue, potentially reducing morbidity and mortality.
Objective:
To develop a prognostic prediction model using the seven warning signs highlighted by WHO revised Dengue fever classification 2009 to determine severe dengue in children.
Methods:
In this prospective analytical study conducted in a tertiary care centre, consecutive sampling of all children aged 1mo to 12y admitted with serologically confirmed Dengue was done from May 2015 through August 2016. After excluding 27 patients with co-infections and co-morbidities, 359 patients were followed up daily to assess clinical and laboratory progression till discharge/ death. Independent predictors were abdominal pain or tenderness, persistent vomiting, lethargy, mucosal bleed, clinical fluid accumulation, hepatomegaly >2 cm and rising hematocrit concurrent with platelet count <100 × 109/L. Outcome measure was severe dengue defined as per WHO guidelines 2009.
Results:
Among 359 children, 93 progressed to severe dengue. In univariate analysis, significant predictors were clinical fluid accumulation (OR 4.773, p = 0.000, 95%CI 2.511-9.075), persistent vomiting (OR 1.944, p = 0.010, 95%CI 1.170-3.225), mucosal bleed (OR 2.045, p = 0.019, 95%CI 1.127-3.711) and hematocrit ≥0.40 concurrent with platelet count <100 × 109/L (OR 2.985, p = 0.000, 95%CI 1.783-4.997). The final multivariable model included clinical fluid accumulation (aOR 3.717, p = 0.000, 95%CI 1.901-7.269), hematocrit ≥0.40 concurrent with platelet count <100 × 109/L (aOR 2.252, p = 0.004, 95%CI 1.302-3.894) and persistent vomiting (p = 0.056) as predictors of severe dengue.
Conclusions:
Among seven WHO warning signs, predictors of severe dengue as suggested by the present multivariable prediction model include clinical fluid accumulation, persistent vomiting and hematocrit ≥0.40 concurrent with platelet count <100 × 109/L.
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