An evaluation of the World Health Organization’s 1997 and 2009 dengue classifications in hospitalized dengue patients in Malaysia

Abstract

Introduction: The latest revised version of the World Health Organization's dengue classification was released in 2009. A handful of studies have taken initiatives to evaluate the old and revised guidelines to determine early signs and symptoms of severe dengue. This retrospective study aimed to compare the classification of dengue using both the 1997 and 2009 guidelines in a selected cohort of dengue patients from Peninsular Malaysia between 2008 and 2012. Methodology: Adult dengue patients were recruited from tertiary hospitals in two different states, Selangor and Kelantan, in Peninsular Malaysia. Their clinical manifestations were assessed. Results: A total of 281 confirmed dengue patients were enrolled; the mean duration of illness at admission was five days. Of these, 88.6%, 10.7%, and 0.7% were classified according to the 1997 guidelines as having dengue fever (DF), dengue hemorrhagic fever (DHF), and dengue shock syndrome (DSS), respectively. When the WHO 2009 guidelines were applied, 17.1%, 78.3%, and 4.6% were classified as dengue without warning signs, dengue with warning signs, and severe dengue, respectively. Conclusions: Our data suggests that the revised WHO 2009 guidelines stratify a much larger proportion of patients into a category that requires a higher level of medical and nursing care.

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

“…Several studies have also highlighted a lack of agreement between the 1997 and 2009 WHO guidelines, and criticised guidelines for failing to provide a categorisation that would help improve treatment and clinical management. Previous studies, however, have used relatively small sample sizes, and many have included only paediatric or hospitalised patients [13][14][15].…”

Multivariable prediction model for predicting deaths in severe dengue cases

“…Zakaria et al demonstrated that the WHO 2009 dengue severity stratification scheme classifies more patients (4•6%) into the most severe form as compared to the previous WHO 1997 scheme (0•7%). 49 They highlighted that this might pose a significant impact on hospital resources. Our model can potentially prioritise patients to local resources based on their probability of death.…”

Definitions for warning signs and signs of severe dengue according to the WHO 2009 classification: Systematic review of literature

“…Thai et al, however, defined it as an increase in hematocrit by more than 15% from the baseline. Instead of the increase from the baseline, 4 studies defined “increase in hematocrit” by using a cutoff value for hematocrit that is adjusted for gender . Moreover, Rodrigues et al defined “increase in hematocrit” by using a nonadjusted cutoff value of hematocrit >48%, with no discrimination between men and women.…”

“…Cardiac involvement as a criterion for “severe dengue” is reported in 12 studies (Table ), with most of them, 8 studies, describing it as “myocarditis.” Two studies used “heart failure” to describe cardiac involvement, while 1 study required the presence of both “myocarditis” and “heart failure” confirmed by echocardiography to fulfill the definition . Hoffmeister et al, however, described the cardiac involvement as “cardiomyopathy.” Except for Lovera et al and Guerrero et al, none of the above mentioned studies reported on the diagnostic criteria for heart failure, cardiomyopathy, or myocarditis.…”