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Criteria of "persistent vomiting" in the WHO 2009 warning signs for dengue case classification.

Vuong NL, Manh DH, Mai NT, Phuc le H, Luong VT, Quan VD, Thuong NV, Lan NT, Nhon CT, Mizukami S, Doan NN, Huong VT, Huy NT, Hirayama K - Trop Med Health (2016)

Bottom Line: To distinguish SD from D/DWS, the ROC curve of the number of vomiting episodes showed that the area under the curve was 0.77; with the cut point of two, the sensitivity and specificity were 92 and 52 %, respectively.The number of vomiting times could be a good clinical sign which can early predict SD from the group of D/DWS.We suggest the definition of persistent vomiting should be vomiting two times or more per day.

View Article: PubMed Central - PubMed

Affiliation: University of Medicine and Pharmacy, 217 Hong Bang, District 5, Ho Chi Minh City, 70000 Vietnam.

ABSTRACT

Introduction: Dengue is a viral disease that spreads rapidly in the tropic and subtropic regions of the world and causes 22,000 deaths annually. In 2009, the World Health Organization (WHO) released a new classification of dengue infections, which divided them into three categories: dengue without warning sign (D), dengue with warning sign (DWS), and severe dengue (SD). However, researchers have been using different criteria to define persistent vomiting; therefore, we aimed to evaluate the ability of the number of vomiting times in early prediction of SD development among D/DWS patients.

Method: A hospital-based cohort study was conducted in Ben Tre-south of Vietnam. We enrolled confirmed dengue patients with D and DWS at admission. The final classification was determined on the discharged day for every patient based on the classification of WHO 2009 without using vomiting symptom, using the receiver operating characteristic (ROC) curve to evaluate the ability of the number of vomiting times in early prediction of SD development among D/DWS patients.

Result: The prevalence of vomiting symptom was higher in SD group than D/DWS group (92 versus 46 %, p = 0.006), and the median of the number of vomiting times was higher in SD group than D/DWS group (2.5 versus 0, p = 0.001). To distinguish SD from D/DWS, the ROC curve of the number of vomiting episodes showed that the area under the curve was 0.77; with the cut point of two, the sensitivity and specificity were 92 and 52 %, respectively.

Discussion: The number of vomiting times could be a good clinical sign which can early predict SD from the group of D/DWS. We suggest the definition of persistent vomiting should be vomiting two times or more per day.

No MeSH data available.


Related in: MedlinePlus

ROC curve of the number of vomiting episodes for predicting SD development among D/DWS patients
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Fig1: ROC curve of the number of vomiting episodes for predicting SD development among D/DWS patients

Mentions: There were 79 patients participated in this study. Among them, female ratio was 51 % (40/79); the median (inter quartile range, IQR) of age was 14 (11–19) years. According to the 2009 WHO classification, the patients with final D/DWS/SD diagnosis were 32/35/12 (41, 44, and 15 %, respectively). The most three frequent clinical signs were vomiting (n = 44, 56 %), abdominal pain or tenderness (n = 35, 44 %), and skin bleeding (n = 30, 38 %). Most of the patients had secondary infection (n = 63, 80 %). When comparing the vomiting sign in the two groups (D/DWS versus SD), the frequency of vomiting sign was significantly higher among patients in SD group (92 %, 11/12) than among patients in D/DWS group (49 %, 33/67); p = 0.013 (chi-square test). In addition, the median (IQR) of the number of vomiting episodes per day was significantly higher in SD group (2.5, 2–3) than in D/DWS group (0, 0–2); p = 0.001 (Mann-Whitney test). Figure 1 shows the ROC curve of the number of vomiting episodes per day when predicting SD, the area under the ROC curve is 0.77. In the cut point of two, the sensitivity and specificity were 92 and 52 %, respectively. With this cut point, we had 43 patients (54 %) with persistent vomiting in this study and we found this warning sign to be associated with the development of SD (odds ratio (OR) 12.0; 95 % confident interval (95 % CI) 1.5–532.2).Fig. 1


Criteria of "persistent vomiting" in the WHO 2009 warning signs for dengue case classification.

Vuong NL, Manh DH, Mai NT, Phuc le H, Luong VT, Quan VD, Thuong NV, Lan NT, Nhon CT, Mizukami S, Doan NN, Huong VT, Huy NT, Hirayama K - Trop Med Health (2016)

ROC curve of the number of vomiting episodes for predicting SD development among D/DWS patients
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4940707&req=5

Fig1: ROC curve of the number of vomiting episodes for predicting SD development among D/DWS patients
Mentions: There were 79 patients participated in this study. Among them, female ratio was 51 % (40/79); the median (inter quartile range, IQR) of age was 14 (11–19) years. According to the 2009 WHO classification, the patients with final D/DWS/SD diagnosis were 32/35/12 (41, 44, and 15 %, respectively). The most three frequent clinical signs were vomiting (n = 44, 56 %), abdominal pain or tenderness (n = 35, 44 %), and skin bleeding (n = 30, 38 %). Most of the patients had secondary infection (n = 63, 80 %). When comparing the vomiting sign in the two groups (D/DWS versus SD), the frequency of vomiting sign was significantly higher among patients in SD group (92 %, 11/12) than among patients in D/DWS group (49 %, 33/67); p = 0.013 (chi-square test). In addition, the median (IQR) of the number of vomiting episodes per day was significantly higher in SD group (2.5, 2–3) than in D/DWS group (0, 0–2); p = 0.001 (Mann-Whitney test). Figure 1 shows the ROC curve of the number of vomiting episodes per day when predicting SD, the area under the ROC curve is 0.77. In the cut point of two, the sensitivity and specificity were 92 and 52 %, respectively. With this cut point, we had 43 patients (54 %) with persistent vomiting in this study and we found this warning sign to be associated with the development of SD (odds ratio (OR) 12.0; 95 % confident interval (95 % CI) 1.5–532.2).Fig. 1

Bottom Line: To distinguish SD from D/DWS, the ROC curve of the number of vomiting episodes showed that the area under the curve was 0.77; with the cut point of two, the sensitivity and specificity were 92 and 52 %, respectively.The number of vomiting times could be a good clinical sign which can early predict SD from the group of D/DWS.We suggest the definition of persistent vomiting should be vomiting two times or more per day.

View Article: PubMed Central - PubMed

Affiliation: University of Medicine and Pharmacy, 217 Hong Bang, District 5, Ho Chi Minh City, 70000 Vietnam.

ABSTRACT

Introduction: Dengue is a viral disease that spreads rapidly in the tropic and subtropic regions of the world and causes 22,000 deaths annually. In 2009, the World Health Organization (WHO) released a new classification of dengue infections, which divided them into three categories: dengue without warning sign (D), dengue with warning sign (DWS), and severe dengue (SD). However, researchers have been using different criteria to define persistent vomiting; therefore, we aimed to evaluate the ability of the number of vomiting times in early prediction of SD development among D/DWS patients.

Method: A hospital-based cohort study was conducted in Ben Tre-south of Vietnam. We enrolled confirmed dengue patients with D and DWS at admission. The final classification was determined on the discharged day for every patient based on the classification of WHO 2009 without using vomiting symptom, using the receiver operating characteristic (ROC) curve to evaluate the ability of the number of vomiting times in early prediction of SD development among D/DWS patients.

Result: The prevalence of vomiting symptom was higher in SD group than D/DWS group (92 versus 46 %, p = 0.006), and the median of the number of vomiting times was higher in SD group than D/DWS group (2.5 versus 0, p = 0.001). To distinguish SD from D/DWS, the ROC curve of the number of vomiting episodes showed that the area under the curve was 0.77; with the cut point of two, the sensitivity and specificity were 92 and 52 %, respectively.

Discussion: The number of vomiting times could be a good clinical sign which can early predict SD from the group of D/DWS. We suggest the definition of persistent vomiting should be vomiting two times or more per day.

No MeSH data available.


Related in: MedlinePlus