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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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