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The Value of Warning Signs From the WHO 2009 Dengue Classification in Detecting Severe Dengue in Children

Mulya Rahma Karyanti1,2, Cuno S P M Uiterwaal2, Sri Rezeki Hadinegoro1

  • 1From the Department of Child Health, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia.

The Pediatric Infectious Disease Journal
|April 23, 2024
PubMed

Insights

In infants, liver enlargement or fluid accumulation are key indicators for severe dengue. In older children, a rising hematocrit with falling platelets best predicts severe dengue, with absence of abdominal pain, vomiting, or fluid accumulation suggesting a lower risk.

Area of Science:

  • Pediatrics
  • Infectious Diseases
  • Public Health

Background:

  • The World Health Organization (WHO) established 7 warning signs in 2009 to identify children at risk of severe dengue.
  • Evaluating the efficacy of these WHO warning signs in pediatric populations is crucial for timely diagnosis and management.

Purpose of the Study:

  • To assess the diagnostic value of the WHO's 7 warning signs for severe dengue in children.
  • To determine the sensitivity, specificity, and predictive values of individual and combined warning signs across different pediatric age groups.

Main Methods:

  • A cross-sectional study analyzed medical records of 614 children with confirmed dengue infection in Jakarta (2009-2018).
  • Children were stratified into three age groups: infants (<1 year), children (1-14 years), and adolescents (15-18 years).
  • The positive and negative predictive values (NPV), sensitivity, and specificity of each warning sign were calculated.

Main Results:

  • Severe dengue occurred in 34.4% of confirmed dengue cases (211/614).
  • In infants, liver enlargement (NPV 80.8%) and clinical fluid accumulation (NPV 75%) were significant indicators. In children and adolescents, increased hematocrit with rapid platelet decrease showed the highest NPV (76.6% and 91.9%, respectively).
  • The presence of multiple warning signs increased the overall NPV across all age groups.

Conclusions:

  • Liver enlargement or clinical fluid accumulation are important predictors of severe dengue in infants; their absence suggests a low likelihood of severe dengue.
  • In older children and adolescents, a concurrent rise in hematocrit and rapid platelet drop is the most discriminative sign for severe dengue.
  • The absence of abdominal pain, vomiting, or fluid accumulation in older children and adolescents indicates a lower risk of severe dengue.
Abstract

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