Daily Dengue Severity Score of Tangnararatchakit et al for Dengue Fever in Pediatric Patients

Description

Tangnararatchakit et al reported a daily dengue severity score for evaluating pediatric patients with dengue fever. The authors are from Mahidol University in Bangkok.

Patient selection: ages from 1 month to 18 years with dengue fever

Parameters:

(1) comorbid risk factors (underlying diseases, obesity, age < 1 years, ibuprofen or aspirin intake)

(2) maximum pulse rate (based on age) in beats per minute

(3) systolic blood pressure in mm Hg

(4) pulse pressure in mm Hg (systolic minus diastolic blood pressure)

(5) time to achieve pulse pressure > 20 mm Hg and normal blood pressure in hours

(6) crystalloid requirements per day

(7) maximum urine output (based on age) in mL/kg/hr

(8) number of bleeding sites (petechiae/ecchymosis; epistaxis; hypermenorrhea; gross hematuria; melena; hematemesis; hematochezia)

(9) volume of colloid infused in mL per kg per day

(10) volume of packed red blood cells transfused in mL per kg per day

(11) number of units of platelet concentrates transfused in units per kg per day

(12) number of major organ dysfunctions (renal, hepatic, encephalopathy, ARDS)

(13) status of re-shock or requiring inotropic drugs

(14) requiring mechanical ventilation

(15) requiring an invasive procedure (placement of central line, blood exchange, etc)

(16) age in years

(17) body weight in kilograms

Parameter	Finding	Points
comorbid risk factors	0	0
	1	3
	2 or more	6
maximum pulse	< 1 year and 1-119 bpm	0
	< 1 year and 120 to 150 bpm	5
	< 1 year and > 150 bpm	8
	< 1 year and 0 bpm	10
	1 to 5 years and 1-99 bpm	0
	1 to 5 years and 100 to 130 bpm	5
	1 to 5 years and > 130 bpm	8
	1 to 5 years and 0 bpm	10
	> 5 years and 1 to 99 bpm	0
	> 5 years and 100 to 120 bpm	5
	> 5 years and > 120 bpm	8
	> 5 years and 0 bpm	10
time to normal pressures	0 hours	0
	<= 1 hour	2
	1.1 to 6 hours	4
	6.1 to 12 hours	6
	12.1 to 24 hours	8
	> 24 hours	10
urine output	< 1 year old and > 1.5 mL/kg/hr	0
	< 1 year old and 1.0 to 1.5 mL/kg/hr	6
	< 1 year old and < 1.0 mL/kg/hr	10
	>=1 year old and > 1.0 mL/kg/hr	0
	>= 1 year old and 0.5 to 1.0 mL/kg/hr	6
	>= 1 year old and < 0.5 mL/kg/hr	10
crystalloid	<= maintenance requirements	0
	maintenance plus < 3% deficit	2
	maintenance plus 3-5% deficit	4
	maintenance plus 5.1 to 7% deficit	6
	maintenance plus 7.1 to 10% deficit	8
	maintenance plus > 10% deficit	10
colloid	none	0
	<= 20 mL/kg/day	1
	21 to 30 mL/kg/day	2
	31 to 40 mL/kg/day	3
	41 to 50 mL/kg/day	4
	> 50 mL/kg/day	5
packed RBCs	none	0
	<= 20 mL/kg/day	1
	21 to 30 mL/kg/day	2
	31 to 40 mL/kg/day	3
	41 to 50 mL/kg/day	4
	> 50 mL/kg/day	5
number of organ failures	none	0
	1	3
	2 or more	6
platelet transfusion	none	0
	<= 0.2 units/kg/day	1
	0.21 to 0.40 units/kg/day	2
	0.41 to 0.60 units/kg/day	3
	0.61 to 0.80 units/kg/day	4
	> 0.80 units/kg/day	5
re-shock or inotropic drug	no	0
	yes	5
mechanical ventilation	no	0
	yes	5
invasive procedure	no	0
	yes	3

Lowest Systolic BP	Lowest Pulse Pressure	Points
>= 90 mm Hg	> 20 mm Hg	0
>= 90 mm Hg	20 mm Hg	2
>= 90 mm Hg	11 to 19 mm Hg	4
>= 90 mm Hg	<= 10 mm Hg	6
< 90 mm Hg	> 0 mm Hg	8
< 90 mm Hg	0 mm Hg	10

raw score for bleeding sites =

= (1 point for petechiae or ecchymosis) + (2 * (number of 6 other bleeding sites))

Raw Score for Bleeding Sites	Points
< 10
>= 10	10

total score =

= SUM(points for all of the parameters)

Interpretation:

• minimum score: 0

• maximum score: 100

• A daily score >= 12 is associated with severe dengue fever.

Performance:

• The sensitivity was 86% and specificity 84%.

• The area under the ROC curve was 0.93 for the daily score on the day before defervescence.

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Daily Dengue Severity Score of Tangnararatchakit et al for Dengue Fever in Pediatric Patients

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