Adherence to Clinical Practice Guidelines (CPG) management of dengue infection in adults (revised 2nd edition).

Marzilawati Abd Rahman ,Izzuna Mudla Mohamed Ghazali,Rafdzah Ahmad Zaki,Erni Zurina Romli,Ker Hong Bee,Shanti Rudra Deva,Shahril Effendi Shuib,Nafisah Ahmad Lutfi,Azahirafairud Abdul Rahim,Cecilia Anthonysamy,Roza Sarimin,Zailiza Suli,Maimunah Mahmud,Balvinder Singh Gill,Rugayah Bakri,Mohd Aminuddin Mohd Yusof ,Mohammed Ariff ,Noormah Mohd Darus ,Ana Fizalinda Abdullah Sani ,Abqariyah Yahya

doi:10.1371/journal.pone.0184559

Abstract

The Malaysian Dengue Clinical Practice Guidelines (CPG) have been developed to provide evidence-based guidance in the management of dengue infections. The use of these guidelines is essential to ensure its recommendations are being practiced. However, the adherence to the guidelines for management of dengue (revised 2nd edition) by healthcare providers still remains unknown. Therefore, the aim of this study was to evaluate the proportion among healthcare providers that adhere to this Dengue CPG. A retrospective cohort study of dengue cases registered from 1 January 2014 to 1 June 2015 was conducted in public hospitals and health clinics in Selangor, Putrajaya and Kuala Lumpur. Adherence to the CPG recommendations were recorded by reviewing patients’ case notes. Overall proportion of adherence in clinical components of the recommendation were (7.1 to 100.0% versus 7.7 to 73.8%) in history taking, (6.7 to 100.0% versus 12.3 to 60.0%) in physical examinations, (18.4 to 100.0% versus 23.1 to 83.2%) in assessment of warning signs, (0.6 to 100.0% versus 12.3 to 87.7%) in assessment of haemodynamic status, (60.0 to 100.0% versus 27.7 to 40.0%) in diagnosis, (46.6 to 80.0% versus 52.3%) in case notifications, (73.2 to 100.0% versus 89.2 to 96.9%) in performing specific laboratory investigations and (7.9 to 100.0% versus 21.5%) in monitoring, for outpatient versus inpatient, respectively. Adherence trends were demonstrated to be higher in hospital settings compared to outpatient settings. Adherence to this Dengue CPG varies widely with overall good clinical outcomes observed.

Highlights

Dengue is the world’s most rapidly spreading and geographically widespread mosquito borne viral disease with an estimated 3.9 billion people in 128 countries currently at risk from dengue as reported by WHO [1]
228 encounters were from Emergency Department (ED), 215 encounters from Medical teams and 5 encounters were from Intensive Care Unit (ICU) teams
From 65 outpatient encounters, 13 cases needed to be referred to hospital, 28 cases were discharged with follow up, and 24 cases were discharged without follow up

Summary

Introduction

Dengue is the world’s most rapidly spreading and geographically widespread mosquito borne viral disease with an estimated 3.9 billion people in 128 countries currently at risk from dengue as reported by WHO [1]. In Malaysia, during the period 2002–2010, the incidence rate of dengue was 125 cases per 100,000 population, with an increasing trend observed in the annual number of dengue cases reported during the same period [2]. A total of 7,103 dengue cases were reported in year 2000, which increased to 46,171 cases in year 2010 [2]. Deaths due to dengue were reported to have increased in the recent years. In 2013, a total 92 dengue deaths were reported in Malaysia, which increased to 215 deaths in 2014 and a further increase to 336 deaths in 2015 [3]

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Conclusion