DOI: 10.5061/dryad.wpzgmsbpp
title: Predictive scoring for risk of complications in pediatric dengue infection

description: 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 &lt;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.
description: 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 =
 Z<sup>2</sup>pqd<sup>2</sup> where n = sample size
 n= (1.96) <sup>2</sup> (0.51)
 (1-0.51) p = proportion of interest (0.06)<sup>2</sup> , 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.
description: Missing values are there in Serum Ferritin, hence this was not
 included in the analysis