Interobserver agreement on signs and symptoms of patients with acute febrile illness

Daumas, Regina Paiva; Brasil, Patrícia; Bressan, Clarisse; Oliveira, Raquel Vc; Carvalho, B B G; Carneiro, Diego Vigna; Passos, Sônia Regina Lambert

doi:10.1007/s15010-011-0101-0

Cited by 4 publications

(11 citation statements)

References 17 publications

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“…All were trained to perform and record standardized clinical evaluations and fill a form containing 28 symptoms and 25 signs potentially useful in the differential diagnosis of febrile illnesses, according to literature review and specialists consensus. Interobserver agreement on signs and symptoms was evaluated in a subsample of 140 patients and was almost perfect (kappa > 0.80) for most collected clinical data [24]. The questionnaire is available online for consultation and details on its development have been described elsewhere [24].…”

Section: Methodsmentioning

confidence: 99%

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Clinical and laboratory features that discriminate dengue from other febrile illnesses: a diagnostic accuracy study in Rio de Janeiro, Brazil

et al. 2013

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BackgroundDengue is an acute febrile illness caused by an arbovirus that is endemic in more than 100 countries. Early diagnosis and adequate management are critical to reduce mortality. This study aims to identify clinical and hematological features that could be useful to discriminate dengue from other febrile illnesses (OFI) up to the third day of disease.MethodsWe conducted a sectional diagnostic study with patients aged 12 years or older who reported fever lasting up to three days, without any evident focus of infection, attending an outpatient clinic in the city of Rio de Janeiro, Brazil, between the years 2005 and 2008. Logistic regression analysis was used to identify symptoms, physical signs, and hematological features valid for dengue diagnosis. Receiver-operating characteristic (ROC) curve analyses were used to define the best cut-off and to compare the accuracy of generated models with the World Health Organization (WHO) criteria for probable dengue.ResultsBased on serological tests and virus genome detection by polymerase chain reaction (PCR), 69 patients were classified as dengue and 73 as non-dengue. Among clinical features, conjunctival redness and history of rash were independent predictors of dengue infection. A model including clinical and laboratory features (conjunctival redness and leukocyte counts) achieved a sensitivity of 81% and specificity of 71% and showed greater accuracy than the WHO criteria for probable dengue.ConclusionsWe constructed a predictive model for early dengue diagnosis that was moderately accurate and performed better than the current WHO criteria for suspected dengue. Validation of this model in larger samples and in other sites should be attempted before it can be applied in endemic areas.

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Section: Methodsmentioning

confidence: 99%

“…Interobserver agreement on signs and symptoms was evaluated in a subsample of 140 patients and was almost perfect (kappa > 0.80) for most collected clinical data [24]. The questionnaire is available online for consultation and details on its development have been described elsewhere [24]. …”

Section: Methodsmentioning

confidence: 99%

Clinical and laboratory features that discriminate dengue from other febrile illnesses: a diagnostic accuracy study in Rio de Janeiro, Brazil

et al. 2013

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“…We used a summarised version of a previously validated semi‐structured sign and symptom standardised questionnaire for AFI (Daumas et al, 2011). The research team received extensive training based on the instrument procedure manual and was instructed on question formulation and tabulation methods used in the tool (available online as a supplementary material of Daumas et al, 2011).…”

Section: Methodsmentioning

confidence: 99%

“…However, they have rarely been used for dengue. Daumas et al (2011) validated a semi‐structured questionnaire and its procedure manual, standardising a clinical approach to AFI, including dengue. These authors found substantial agreement for most of the signs and symptoms, suggesting that the standardised instrument could be helpful in evaluating AFI.…”

Section: Introductionmentioning

confidence: 99%

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Pitfalls in acute febrile illness diagnosis: Interobserver agreement of signs and symptoms during a dengue outbreak

Buonora

Passos

Daumas

et al. 2020

Journal of Clinical Nursing

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Aims and objectives To compare and evaluate interobserver (nurses and physicians) agreement for dengue clinical signs and symptoms, including the World Health Organization diagnostic algorithm. Background Agreement of clinical history defines the capacity of the examiner to measure a given clinical parameter in a reproducible and consistent manner, which is prerequisite for diagnosis validity. Nurses play a major role in the triage and care of dengue patients in many countries. Study design This is a sub‐study on interobserver agreement performed as part of a cross‐sectional diagnostic accuracy study for acute febrile illness (AFI) using the checklist STARD. Methods A previously validated semi‐structured sign and symptom standardised questionnaire for AFI was independently administered to 374 patients by physician and nurse pairs. The interobserver agreement was estimated using kappa statistics. Results For a set of 27 signs and symptoms, we found six interobserver discrepancies (examiner detected red eyes, lethargy, exanthema, dyspnoea, bleeding and myalgia) as identified by regular and moderate kappa indexes. Four signs (patient observed red eyes, cough, diarrhoea and vomiting) and one symptom (earache) had near‐perfect agreement. Most signs and symptoms showed substantial agreement. The WHO (Dengue guidelines for diagnosis, treatment, prevention and control: new edition, World Health Organization, 2009) clinical criteria for dengue comprise a group of symptoms known as “pains and aches.” Interobserver agreement for abdominal pain, retro‐orbital pain and arthralgia exceed that found for headache and myalgia. Conclusions During a dengue outbreak, the interobserver agreement for most of the signs and symptoms used to assess AFI was substantial. Relevance to clinical practice This result suggests good potential applicability of the tool by health professionals following training. A well‐trained health professional is qualified to apply the standardised questionnaire to evaluate suspected dengue cases during outbreaks.

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Rickettsia parkeri in Amblyomma dubitatum ticks in a spotted fever focus from the Brazilian Pampa

Weck¹,

Dall’Agnol²,

Souza³

et al. 2017

Acta Tropica

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Spotted fever is an acute febrile illness, which is considered severely underreported and misdiagnosed in the Brazilian Pampa, caused by tick-borne Rickettsiae. Here, we report an eco-epidemiological investigation of Rickettsia spp. in ticks from a spotted fever focus in Toropi, southern Brazil. Ticks were collected from capybara carcasses and processed individually to obtain genomic DNA. Rickettsia was investigated using PCR that amplified the rickettsial fragments of the gltA, ompA and htrA genes. DNA from Rickettsia parkeri was found in four of 14 Amblyomma dubitatum ticks collected from capybara carcasses in Toropi and the nearby municipality of Quevedos. We also tested 210A. dubitatum ticks obtained from road-killed capybaras of other localities from the Pampa biome; none of them were positive for Rickettsiae. Thus, in Rio Grande do Sul, two Rickettsia species can be potentially associated to spotted fever: Rickettsia sp. strain Atlantic Rainforest, associated with Amblyomma ovale ticks in the Atlantic Rainforest biome, and R. parkeri, associated both with Amblyomma tigrinum and A. dubitatum ticks in the Pampa biome. Our results reinforce that R. parkeri may be the agent associated with spotted fever in the Brazilian Pampa.

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Interobserver agreement on signs and symptoms of patients with acute febrile illness

Cited by 4 publications

References 17 publications

Clinical and laboratory features that discriminate dengue from other febrile illnesses: a diagnostic accuracy study in Rio de Janeiro, Brazil

Clinical and laboratory features that discriminate dengue from other febrile illnesses: a diagnostic accuracy study in Rio de Janeiro, Brazil

Pitfalls in acute febrile illness diagnosis: Interobserver agreement of signs and symptoms during a dengue outbreak

Rickettsia parkeri in Amblyomma dubitatum ticks in a spotted fever focus from the Brazilian Pampa

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