Efficacy of Clinical Diagnosis of Dengue Fever in Paediatric Age Groups as Determined by WHO Case Definition 1997 in Thailand
Efficacy of Clinical Diagnosis of Dengue Fever in Paediatric Age Groups as Determined by WHO Case Definition 1997 in Thailand
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根据 1997 年世界卫生组织病例定义确定的泰国儿童登革热临床诊断效果
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发表时间：
2001
期刊：
影响因子：
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通讯作者：
Sophon Iamsirithavorn
中科院分区：
文献类型：
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作者：
Siraporn Sawasdivorn;Sasitorn Vibulvattanakit;Malee Sasavatpakdee;Sophon Iamsirithavorn
1998年9月至1999年9月在曼谷Sawanpracharak医疗中心儿科进行了一项描述性的横断面研究。在整个住院期间，对暂时诊断为登革热感染的患者进行随访。每日记录病人的症状、体格检查结果和实验室数据。根据WHO 1997病例定义，儿科医生在出院时对DF/DHF/DSS或其他发热性疾病进行临床诊断。在研究期间，根据最初的入院诊断招募了176名1-13岁的患者。在住院结束时，71例患者（40%）被诊断为DF由他们的儿科医生。根据ELISA和/或PCR，只有45人被证实患有DF。根据WHO 1997年DF病例定义，本研究的敏感性、特异性、PPV和NPV分别为100%、21.21%、63.38%和100%。45例确诊病例样本中前4位临床表现依次为发热100%、止血带试验阳性86.67%、头痛80.48%、白细胞减少62.22%。通过使用发热与其他两种临床表现，只有发热与止血带试验阳性和白细胞减少症区分DF与其他发热性疾病（p=0.042），并具有最高的预测价值（PPV=72.72%）。还发现发热伴止血带试验阳性或发热伴白细胞减少伴另一种临床表现比发热伴任何两种临床表现的PPV发生率更高。研究表明，WHO对DF的病例定义具有很高的敏感性，但过度诊断的风险高达36.62%（PPV=63.38%）。为了降低这一风险，研究发现，发热伴止血带阳性和白细胞减少的组合是最好的（PPV=72.72%）。发热伴止血带阳性或白细胞减少症与其他临床表现的组合（PPV=72.72%~ 61.53%）优于发热伴任何两种临床表现（PPV= 64.2%~ 40.00%）。
A descriptive cross-sectional study was undertaken at the Paediatrics department of the Sawanpracharak Medical Centre, Bangkok, from September 1998 to September 1999. Patients admitted with a tentative diagnosis of dengue infection were followed throughout their hospital stay. Daily records were kept of the patients' symptoms, their physical examination findings and laboratory data. Clinical diagnosis of DF/DHF/DSS or other febrile illness was made by paediatricians at the time of discharge based on the WHO 1997 case definition. During the study, 176 patients, aged 1-13 years, were recruited based on initial admission diagnosis. At the end of hospitalization, 71 patients (40%) were diagnosed as having DF by their paediatricians. Based on ELISA and/or PCR, only 45 were confirmed to have DF. In the study of our population, the sensitivity, specificity, PPV and NPV according to the WHO 1997 DF case definition were 100%, 21.21%, 63.38% and 100% respectively. The four leading clinical manifestations in the sample of 45 confirmed cases included: fever 100%, positive tourniquet test 86.67%, headache 80.48% and leukopenia 62.22%. By using fever with two other clinical manifestations, only fever with positive tourniquet test and leukopenia differentiated DF from other febrile illness (p=0.042) and had the highest predictive value (PPV=72.72%). It was also found that fever with positive tourniquet test, or fever with leukopenia with one other clinical manifestation, had a higher chance of more PPV than fever combined with just any two clinical manifestations. The study brought out the fact that WHO case definition for DF has very high sensitivity but runs the risk of over-diagnosis to the extent of 36.62% (PPV=63.38%). To reduce this risk, the study found that the combination of fever with positive tourniquet and leukopenia was the best (PPV=72.72%). The combination of fever with positive tourniquet or leukopenia and one other clinical manifestation (PPV=72.72%-61.53%) was better than fever with any two clinical manifestations (PPV=64.2%40.00%).
影响因子：
6.4
作者：
Kalayanarooj, S;Vaughn, DW;Ennis, FA
通讯作者：
Ennis, FA