Factors Associated with Correct Dengue Patient Admission Practices in Puerto Rico with Respect to 2009 World Health Organization Guidelines Open Access
Roth, Nicole (2015)
Published
Abstract
Background: Dengue is a major public health concern with an estimated 96 million clinically apparent infections in 2010. This paper describes an observational study of the association of the clinical and demographic characteristics of dengue patients with criteria for hospital admission according to the 2009 World Health Organization (WHO) guidelines.
Methods: The Sentinel-Enhanced Dengue Surveillance System (SEDSS) is a population-based acute febrile illness (AFI) surveillance and clinical research platform. Patients with AFI presenting to SEDSS sites are identified by triage nurses and offered enrollment. During May 6, 2012-May 7, 2013, a total of 595 patients accepted enrollment in SEDSS and had laboratory evidence of dengue virus infection. The outcome of interest in the study was an admission decision by the physician that followed the 2009 WHO dengue guidelines. The exposure of interest was criteria for admission as outlined by the 2009 WHO guidelines, which categorizes patients into three groups. Group A patients do not have any warning signs or coexisting conditions and may recover at home. Group B patients have dengue warning signs or coexisting conditions (e. g. diabetes, pregnancy) and Group C patients any manifestations of severe dengue, such patients require hospitalization.
Results: Of the 595 study participants, sixty-seven (11%) were classified as Group A, of which 75% were correctly admitted. Four hundred sixty-nine were classified as Group B and 59 were classified as Group C, of which 49% and 66% were correctly admitted, respectively. Diagnosis of dengue at presentation was significantly associated with correct admission decision (OR: 4.4, CI: 3.0-6.39). Group B patients with abdominal pain, persistent vomiting, or increase in hematocrit concurrent with decrease in platelet count had increased odds of correctly being admitted. Group A patients with rash, bone pain, or back pain had increased odds of correctly being discharged.
Conclusions: This study identified underutilization of the 2009 WHO dengue admission guidelines Strict utilization of the guidelines would result in a significant increase in the hospitalization burden by dengue patients, and therefore further investigation into the specific criteria that can be used to safely monitor patients as outpatients is needed.
Table of Contents
Background…………………………………………………………………...…………………1
Methods………………………………………………………………………...………………..6
Results………………………………………………………………………………………..….11
Discussion……………………………………………...……………………………………….17
References……………………………………………………………………………………….22
Tables………………………………………………………………………………………..…...26
Figures...…………………………………………………………………………………………34
Appendix...……………………………………………………………………………………...36
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