Soria SC, González RD, Izquierdo EA, Martínez TE

Language: Spanish
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ABSTRACT

Introduction: dengue virus infection has had a dramatic increase, with a population at risk of 8 220 000 inhabitants in Ecuador.
Objectives: determine the usefulness of the reclassification of cases of dengue fever, dengue hemorrhagic fever and dengue hemorrhagic fever / dengue shock syndrome, according to the WHO 2009 Dengue Clinical Guide, and identify the signs of alarm and their relationship to disease severity.
Methods: a cross-sectional ambispective study was conducted between the years 2005 and 2006 (retrospective) and from April to November 2009 (prospective). The latter period followed a training intervention (WHO 2009 Guide). The study was conducted in primary and tertiary units based on randomly selected medical records.
Results: fifty records were analyzed in the first period and 72 in the second, with a moderate (kappa= 0.51; CI 95% 0.18-0.85) and insignificant (kappa= 0.3; CI 95% 0-0.71) level of agreement, respectively, for the two classifications. Sensitivity of the 2009 classification for the detection of severe cases was 86.36 % (CI 95% 71.9 % 5-94.33 %), and specificity was 83.3 % (CI 95% 36.48 %-99.12 %). For both periods, sensitivity was 100 % (CI 95% 61.0 %-100 %) and specificity was 59.09 % (CI 434.4 %-72.30 %). Identification of alarm signs and their relationship to dengue severity showed a sensitivity of 100 % (CI 95% 61.0 %-100 %) and a specificity of 59.09 % (CI 434.4 %-72.30 %) in the first period, and a sensitivity of 100 % (CI 95% 46.29 % 5-98.13 %) and a specificity of 46.27 % (CI 95% 34.17 %-58.80 %) in the second.
Conclusions: the WHO 2009 classification is useful for the timely, effective management of patients, with alarm signs that are good predictors of shock.