Dengue Fever Scoring System: New Strategy for the Early Detection of Acute Dengue Virus Infection in Taiwan

Chang, Ko; Lu, Po-Liang; Ko, Wen-Chien; Tsai, Jih-Jin; Tsai, Wu-Hsiung; Chen, Chaur-Doug; Chen, Yen-Hsu; Chen, Tun-Chieh; Hsieh, Hsiao-Chen; Pan, Chao-Ying; Harn, Ming-Rong

doi:10.1016/S0929-6646(09)60420-4

« Previous Next »Journal of the Formosan Medical Association
Volume 108, Issue 11 , Pages 879-885, November 2009

Dengue Fever Scoring System: New Strategy for the Early Detection of Acute Dengue Virus Infection in Taiwan

Ko Chang
- Department of Internal Medicine, College of Medicine, Kaohsiung Municipal Hsaio-Kang Hospital, Tainan, Taiwan
- Department of Internal Medicine, Kaohsiung Municipal Hsaio-Kang Hospital, Tainan, Taiwan
Po-Liang Lu
- Department of Internal Medicine, College of Medicine, Kaohsiung Municipal Hsaio-Kang Hospital, Tainan, Taiwan
- Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Laboratory of Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
Wen-Chien Ko
- Division of Infectious Diseases, Department of Internal Medicine, National Cheng Kung University, Tainan, Taiwan
Jih-Jin Tsai
- Department of Internal Medicine, College of Medicine, Kaohsiung Municipal Hsaio-Kang Hospital, Tainan, Taiwan
- Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
Wu-Hsiung Tsai
- Bureau of Public Health, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
Chaur-Doug Chen
- Bureau of Public Health, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
Yen-Hsu Chen
- Department of Internal Medicine, College of Medicine, Kaohsiung Municipal Hsaio-Kang Hospital, Tainan, Taiwan
- Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
Tun-Chieh Chen
- Department of Internal Medicine, College of Medicine, Kaohsiung Municipal Hsaio-Kang Hospital, Tainan, Taiwan
- Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
Hsiao-Chen Hsieh
- Department of Internal Medicine, College of Medicine, Kaohsiung Municipal Hsaio-Kang Hospital, Tainan, Taiwan
- Department of Internal Medicine, Kaohsiung Municipal Hsaio-Kang Hospital, Tainan, Taiwan
Chao-Ying Pan
- Bureau of Public Health, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
Ming-Rong Harn
- Department Graduate Institute of Occupational Safety and Health, Kaohsiung Medical University, Tainan, Taiwan
- Correspondence to: Dr Ming-Rong Harn, Graduate Institute of Occupational Safety and Health, Kaohsiung Medical University, 370 Zer-Her 1^st Street, 807 Kaohsiung, Taiwan

Received 4 October 2008; received in revised form 19 May 2009; accepted 21 May 2009.

Background/Purpose

Dengue fever is an important public health problem in Southern Taiwan. The purpose of this study was to develop a dengue scoring system using a three-stage process, which may be used as a guidance tool for the early diagnosis of dengue fever.

Methods

A retrospective study was conducted to identify factors useful for the early diagnosis of dengue fever. We assessed the clinical and laboratory features of 89 adult patients with dengue from 2002 to 2004 at a community-based hospital. They were compared with 14 patients with scrub typhus, 104 with Q fever, and 35 with murine typhus, which might present similar symptoms and signs as dengue infection. A scoring system was designed after analysis of the retrospective study and with the assistance of 10 expert clinicians. For the second stage, we evaluated efficiency in differentiating dengue fever from Q fever, scrub typhus and murine typhus in three hospitals from 2002 to 2005. For the third stage, we prospectively used the dengue scoring system for 498 cases that clinically were suspected as having dengue infection in the city of Kaohsiung from January 2006 to September 2006.

Results

The performance of the scoring system was 88.1% sensitivity, 94.9% specificity, 95.7% positive predictive value (PPV), and 86.1% negative predictive value (NPV). Evaluation of the scoring system at the third stage revealed 90.7% sensitivity, 86.9% specificity, 81.4% PPV, and 93.6% NPV.