Comparison of clinical and laboratory characteristics between severe and non-severe dengue in paediatrics

BackgroundThe timely identification of severe dengue in peadiatric patients is of utmost importance, as any delay in diagnosis could lead to an irreversible state of shock potentially leading to fatal consequences. The primary aim of our study was to characterize dengue severity in paediatric patients based on initial symptoms, signs, and laboratory investigation of their presentation in the emergency department.MethodologyWe conducted a retrospective data retrieval from the medical records of 254 paediatric patients who had been diagnosed with confirmed cases of dengue fever. The clinical characteristics were compared between severe and non-severe dengue. Multiple logistic regression analysis was utilised to elucidate the variables that exhibited associations with severe dengue.ResultsA total of 254 paediatric patients were included, among whom 15.4% (n = 39) were diagnosed with severe dengue. Multiple logistic regression analysis identified lethargy, systolic blood pressure (SBP) below 90 mmHg, capillary refilled time (CRT) longer than 2 seconds, ascites, and hepatomegaly were independently associated with severe dengue.ConclusionIn paediatric patients, severe dengue is associated with specific clinical indicators, including lethargy, low systolic blood pressure, prolonged capillary refill time (CRT), and the presence of ascites and hepatomegaly. Identifying these clinical features early is crucial for primary care physicians, as it enables accurate diagnosis and timely intervention to manage severe dengue effectively. Cheras is a suburban area located in the Klang Valley region of Malaysia. In recent years, the population of Cheras has grown rapidly due to urbanization and economic development in the surrounding areas. Cheras has a relatively high population density (N = 135,823, 8,489 / km2) with a mix of high-rise apartment buildings, landed residential properties, and commercial areas. The area is well-connected to other parts of the Klang Valley via major highways and public transportation, which also contributes to the population density. The present study documented clinical and laboratory profiles of 254 paediatric patients with dengue who presented in the emergency department between November 2018 to November 2019 at the only hospital in Cheras, a prevalent dengue area. Patients had an average age of 13 years old, and the male-to-female ratio was nearly balanced. More than 15% had severe dengue manifestation. We found the independent clinical risk factors for severe dengue in paediatric patients include lethargy, systolic blood pressure (SBP) below 90 mmHg, capillary refilled time (CRT) longer than 2 seconds, ascites, and hepatomegaly. Early recognition of these manifestations will assist primary care physicians in making correct diagnosis with timely intervention and management. The presence of dengue in a high-density population and rapidly growing zone warrants further holistic actions to reduce its impact on children's health.