DAILY DENGUE SEVERITY SCORE – IMPLICATIONS, BENEFITS AND LIMITATIONS IN OUR SETTING

Abstract

Introduction- Dengue is associated with high morbidity & at times develops potentially fatal complication. Predicting the outcome on the basis of clinical presentation alone is less reliable and complicated owing to variable symptomatology. there is a need for developing and testing a scoring system, for the detection of complicated and severe dengue fever early in the course of infection, to identify those children who may progress to DSS/DHF and succumb to disease subsequently & to triage sick patients for early referral from primary and community health centers to higher center for intensive care management. This Material & methodsProspective observational study was conducted in Department of Pediatrics, SMS Medical College, Jaipur during January 2020 to September 2021. Sample size is calculated at 95 % condence interval expecting sensitivity of 86% using dengue severity score of more than equal to 12 in the assessment of outcome of dengue severity among the dengue fever patients. An absolute allowable error of 15% and at prevalence of 17.4% of severe dengue patients, the required sample size was 125 cases with dengue fever. Statistical analyses were done using computer software (SPSS Trial version 23 and primer). if we use the critical cut off of DDS Results- S >10.5 on day 1 of hospital admission; it was a strong predictor of mortality with p <0.001 and area under curve was 0.906 which is near 1. The sensitivity of score at this cutoff was 100% and specicity was 71.7%. The cutoff was chosen as 10.5 because at this cut off both sensitivity and specicity were reasonably high and below this score although sensitivity remains 100% but specicity decreases i.e., false positive cases would increase and if cutoff is increased then specicity increases but sensitivity decreases i.e., false negative increases. If cutoff was chosen at 16.5 sensitivity of score decreases to 83.3% but specicity increases to 85%. On cutoff of 22 sensitivity decreases to 50% and specicity increases to 90.3%. Conclusions- If critical cutoff more than 10.5 is used, dengue shock syndrome can be predicted with specicity of 82.5% and sensitivity of 94.6%. If critical cutoff of more than 8.5 is used, prolonged length of hospital stay can be predicted with sensitivity and specicity of 51.9% and 53.1% respectively. If critical cutoff of more than 11.5 is used then organ dysfunction in dengue patients can be predicted with sensitivity of 78.9% and specicity of 89.7% respectively. If critical cutoff of more than 10.5 is used then mortality in dengue patients can be predicted with sensitivity100% of and specicity of 71.7%