Predictive scoring for risk of complications in pediatric dengue infection
Mahalingam, Soundarya; Bhaskar, Monisha; Achappa, Basavaprabhu; MM, Harish (2022), Predictive scoring for risk of complications in pediatric dengue infection, Dryad, Dataset, https://doi.org/10.5061/dryad.wpzgmsbpp
Background: Dengue infection has been a worrisome cause of mortality and morbidity in children. Though numerous scoring systems have been developed, they are in the adult population or are too complicated for use in children. Pediatric dengue infection has a wide spectrum from a mild illness to severe complications and an unpredictable course. Hence the need for a predictive scoring system where the possibility of complications can be identified which can contribute to reduction in mortality and morbidity of dengue by prompt referrals and anticipatory management.
Methodology: Prospective case cohort study of children with confirmed dengue.
Results: 303 children were included and divided into two groups – the dengue fever group and the complicated dengue group based on the WHO clinical classification. The clinical and laboratory parameters were analysed individually, cut offs identified by ROC curves and compared for significance between the two groups. The parameters that emerged were hypotension, PCV ≥ 42%, platelet count ≤ 75000 cells/cumm, WBC ≥ 7000 cells/cumm, and ALT ≥ 70U/L. Using the adjusted odd’s Ratio, and coefficient, individual predictive scores were tabulated ranging from 0 to 3, with a total score of 0 to 7. A cut-off score of 2 was then identified based upon the sensitivity(84.13%) and specificity(72.50%) as the ideal score to predict complicated dengue. Internal validation of the score was done where the area under the curve for predicting complicated dengue was 0.86(95% CI 0.8-0.92) with a P value of <0.001.
Conclusion: Our dengue predictive scoring system has been developed using five indicators, with a score of 2 and above out of 7, suggesting increased risk of developing complications. This has been validated internally and can be used to predict complicated dengue among children.
Study design: This was a prospective case cohort study
Study population: All children aged 0 – 18 years with dengue infection
Study duration: 5 years, from Jan 2016 to December 2020
Study setting: Hospital based study in the two tertiary medical college hospitals associated with our medical college.
Sample size : 270
n = Z2pqd2 where n = sample size
n= (1.96) 2 (0.51) (1-0.51) p = proportion of interest (0.06)2 , q = 1-p and d = relative precision
In order to cover the time period, all cases in this time interval were included with a minimum of 270. Hence all 303 cases were considered.
Inclusion criteria: All cases of confirmed dengue cases with NS1 antigen positivity confirmed by IgM dengue ELISA positivity after 5 days.
Exclusion criteria: All cases who had an acute febrile illness with clinical features of dengue fever but negative diagnostic tests.
Demographic details, mode of presentation, clinical findings, laboratory parameters, treatment parameters and outcomes of all the included children were recorded and taken up for further analysis using a data extraction sheet. The children were classified into two groups – The dengue fever group and the Complicated dengue group based upon the WHO classification.
Missing values are there in Serum Ferritin, hence this was not included in the analysis