ArticleIndian pediatrics2020
WHO 2009 Warning Signs as Predictors of Time Taken for Progression to Severe Dengue in Children.
Article in Indian pediatrics, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.
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Who cites it
2 citing papers in PubMed.
- Early individualized risk prediction using clinical data for children during the febrile phase of dengue in outpatient settings in Vietnam and Thailand.PLOS digital health · 2026Article
- Refining Clinical Triage and Management of Dengue Infection in Children: A Timely Approach.Indian pediatrics · 2020Article
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3 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectivesTo identify WHO 2009 warning signs that can predict time taken for progression to severe dengue in a pediatric population.
designProspective analytical study over 1 year and 2 months.
settingTertiary care center.
results
participants350 children aged 1 mo-12 y with serologically confirmed dengue without co-morbidities/co-infections; conse-cutive sampling. PROCEDURE: At admission, clinical and laboratory details were noted. Disease progression, time of onset of each warning sign, hematocrit, and platelet counts were recorded daily till discharge/ death. If progressing to severe dengue, its time of onset was noted. Time to event analysis with Log Rank test, Kaplan Meier plots and Cox Proportional Hazards Model was done. OUTCOME MEASURES: Primary outcome was time interval from onset of first warning sign to onset of severe dengue (defined as per WHO 2009 guidelines). Predictors were WHO 2009 warning signs: abdominal pain, lethargy, persistent vomiting, mucosal bleed, clinical fluid accumulation, hepatomegaly >2 cm, hematocrit ≥0.40 and platelet count <100x109/L.
resultsAmong 350 children followed up completely till discharge/death, 90 developed severe dengue (event) while 260 did not (censored). Median age of study population was 7.75 y. Clinical fluid accumulation [(P=0.002, Hazard Ratio (HR) 2.19, 95% CI 1.33-3.60)] and hematocrit ≥0.40 [(P=0.009, HR (95%CI) 1.715, (1.13-2.60)] were significant in univariate analysis. Final multivariate model includes clinical fluid accumulation [(P=0.02, HR (95%CI) 1.89, (1.116-3.202)], hematocrit ≥0.40 (P=0.07), mucosal bleed (P=0.56) and persistent vomiting (P=0.32).
conclusionWHO warning signs that predict time taken for progression to severe dengue in children include clinical fluid accumulation, hematocrit ≥0.40, persistent vomiting and mucosal bleed. Study results have implications in policy making and practice guidelines to triage children attending a health care facility with or without warning signs.
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