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. 2014 Apr 28;9(4):e96314.
doi: 10.1371/journal.pone.0096314. eCollection 2014.

Sensitivity and specificity of the World Health Organization dengue classification schemes for severe dengue assessment in children in Rio de Janeiro

Gleicy A Macedo  1 , Michelle Luiza C Gonin  2 , Sheila M Pone  3 , Oswaldo G Cruz  3 , Flávio F Nobre  1 , Patrícia Brasil  3
Affiliations

Sensitivity and specificity of the World Health Organization dengue classification schemes for severe dengue assessment in children in Rio de Janeiro

Gleicy A Macedo et al. PLoS One. .

Abstract

Background: The clinical definition of severe dengue fever remains a challenge for researchers in hyperendemic areas like Brazil. The ability of the traditional (1997) as well as the revised (2009) World Health Organization (WHO) dengue case classification schemes to detect severe dengue cases was evaluated in 267 children admitted to hospital with laboratory-confirmed dengue.

Principal findings: Using the traditional scheme, 28.5% of patients could not be assigned to any category, while the revised scheme categorized all patients. Intensive therapeutic interventions were used as the reference standard to evaluate the ability of both the traditional and revised schemes to detect severe dengue cases. Analyses of the classified cases (n = 183) demonstrated that the revised scheme had better sensitivity (86.8%, P<0.001), while the traditional scheme had better specificity (93.4%, P<0.001) for the detection of severe forms of dengue.

Conclusions/significance: This improved sensitivity of the revised scheme allows for better case capture and increased ICU admission, which may aid pediatricians in avoiding deaths due to severe dengue among children, but, in turn, it may also result in the misclassification of the patients' condition as severe, reflected in the observed lower positive predictive value (61.6%, P<0.001) when compared with the traditional scheme (82.6%, P<0.001). The inclusion of unusual dengue manifestations in the revised scheme has not shifted the emphasis from the most important aspects of dengue disease and the major factors contributing to fatality in this study: shock with consequent organ dysfunction.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

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Grants and funding

This work was supported by grants from Rede Dengue FIOCRUZ and Fundação de Amparo a Pesquisa do Estado do Rio de Janeiro – FAPERJ, under notice number 10/2008 for supporting research about neglected and reemerging diseases. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

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