Low sensitivity of the tourniquet test for differential diagnosis of dengue: an analysis of 28,000 trials in patients

Furlan, Nathália Barbosa; Tukasan, Caroline; Estofolete, Cássia Fernanda; Nogueira, Maurício Lacerda; Silva, Natal Santos da

doi:10.1186/s12879-016-1947-7

Cited by 8 publications

(6 citation statements)

References 41 publications

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“…Both leukopenia and leukocytosis have been described in dengue, depending on the timing during illness [ 11 , 29 , 30 ]. Our findings for the tourniquet test were consistent with other studies which showed a crucial role for this clinical parameter in predictive models for acute dengue illnesses [ 7 , 15 , 31 ].…”

Section: Discussionsupporting

confidence: 92%

Use of structural equation models to predict dengue illness phenotype

et al. 2018

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BackgroundEarly recognition of dengue, particularly patients at risk for plasma leakage, is important to clinical management. The objective of this study was to build predictive models for dengue, dengue hemorrhagic fever (DHF), and dengue shock syndrome (DSS) using structural equation modelling (SEM), a statistical method that evaluates mechanistic pathways.Methods/FindingsWe performed SEM using data from 257 Thai children enrolled within 72 h of febrile illness onset, 156 with dengue and 101 with non-dengue febrile illnesses. Models for dengue, DHF, and DSS were developed based on data obtained three and one day(s) prior to fever resolution (fever days -3 and -1, respectively). Models were validated using data from 897 subjects who were not used for model development. Predictors for dengue and DSS included age, tourniquet test, aspartate aminotransferase, and white blood cell, % lymphocytes, and platelet counts. Predictors for DHF included age, aspartate aminotransferase, hematocrit, tourniquet test, and white blood cell and platelet counts. The models showed good predictive performances in the validation set, with area under the receiver operating characteristic curves (AUC) at fever day -3 of 0.84, 0.67, and 0.70 for prediction of dengue, DHF, and DSS, respectively. Predictive performance was comparable using data based on the timing relative to enrollment or illness onset, and improved closer to the critical phase (AUC 0.73 to 0.94, 0.61 to 0.93, and 0.70 to 0.96 for dengue, DHF, and DSS, respectively).ConclusionsPredictive models developed using SEM have potential use in guiding clinical management of suspected dengue prior to the critical phase of illness.

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Section: Discussionsupporting

confidence: 92%

Use of structural equation models to predict dengue illness phenotype

et al. 2018

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“…13 Similarly, a retrospective analysis of >28 000 tourniquet tests found no association between test results and final laboratory-confirmed diagnosis or dengue severity. 14 Increasing the diagnostic cut-off from >10 petechiae to >20 petechiae did not result in the expected decrease in sensitivity and increase in specificity. This poor biological correlation between dengue infection and capillary fragility may be underlying the test’s poor diagnostic performance.…”

Section: Clinical Diagnosismentioning

confidence: 86%

“…This poor biological correlation between dengue infection and capillary fragility may be underlying the test’s poor diagnostic performance. 13 Combined with practical considerations such as difficulty of interpretation in different skin colours and uncertainties around its positivity in other flavivirus infections, 14 it may be time to forgo the tourniquet test as a diagnostic criterion for dengue.…”

Section: Clinical Diagnosismentioning

confidence: 99%

A review of dengue diagnostics and implications for surveillance and control

Raafat

Blacksell

Maude

2019

Transactions of the Royal Society of Tropical Medicine and Hygiene

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Dengue is the world’s most common arboviral infection, with almost 4 billion people estimated to be living at risk of dengue infection. A recently introduced vaccine is currently recommended only for seropositive individuals in a restricted age range determined by transmission intensity. With no effective dengue vaccine for the general population or any antiviral therapy, dengue control continues to rely heavily on vector control measures. Early and accurate diagnosis is important for guiding appropriate management and for disease surveillance to guide prompt dengue control interventions. However, major uncertainties exist in dengue diagnosis and this has important implications for all three. Dengue can be diagnosed clinically against predefined lists of signs and symptoms and by detection of dengue-specific antibodies, non-structural 1 antigen or viral RNA by reverse transcriptase–polymerase chain reaction. All of these methods have their limitations. This review aims to describe and quantify the advantages, uncertainties and variability of the various diagnostic methods used for dengue and discuss their implications and applications for dengue surveillance and control.

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“…The clinical variables that were added in WHO 2009, such as organ failure, may not necessarily represent a direct consequence of dengue, but of prior comorbidity or even iatrogenesis, as is the case of pulmonary distress due to hyperhydration . Even classical information adopted in both classifications may not express the clinical reality in dengue patients; the tourniquet test has been shown to have a low sensitivity in dengue diagnosis , and, since many DENV‐infected patients could be non‐febrile, fever may not be a reliable starting point criterion .…”

Section: Discussionmentioning

confidence: 99%

Comparison between the traditional (1997) and revised (2009) WHO classifications of dengue disease: a retrospective study of 30 670 patients

Silva

Undurraga

Verro

et al. 2018

Tropical Med Int Health

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Objective To compare WHO's traditional (1997) and revised (2009) guidelines for dengue classification, using a large sample of patients of all ages with varying clinical conditions from a dengue‐endemic area in Brazil. Methods We compared 30 670 laboratory‐confirmed dengue cases (1998–2012) using both WHO's dengue classification guidelines. Stereotype ordinal logistic regressions were used to analyse the association between patients’ demographics and signs and symptoms related to dengue infection severity, as defined in the 1997 and 2009 guidelines. We then compared the degree of agreement in dengue classification of both guidelines. Results Dengue signs and symptoms in patients were poorly correlated to disease severity as defined by both guidelines (Cramer's V test <0.2). Hypotensive shock was the exception for both classifications, presenting dependence (Z = 56.42; P < 0.001, and Z = 55.24; P < 0.001) and high agreement (Cramers's V = 1; P < 0.001, and Cramers's V = 0.97; P < 0.001) for WHO 1997 and 2009, respectively. Last, we also found substantial agreement in disease classification between both guidelines (Kendall tau‐b = 0.79; P < 0.001), although 2009 guidelines were more sensitive in the detection of severe cases. Conclusions We hope our results will inform the debate about dengue classification guidelines, particularly concerning clinical value, study comparability, and ways in which future guidelines can support the clinical management of dengue. Our results suggest that caution should be taken when using WHO guidelines to assess dengue severity to improve clinical management of patients.

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Low sensitivity of the tourniquet test for differential diagnosis of dengue: an analysis of 28,000 trials in patients

Cited by 8 publications

References 41 publications

Use of structural equation models to predict dengue illness phenotype

Use of structural equation models to predict dengue illness phenotype

A review of dengue diagnostics and implications for surveillance and control

Comparison between the traditional (1997) and revised (2009) WHO classifications of dengue disease: a retrospective study of 30 670 patients

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