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Global problems
P2-430 WHO/TDR new dengue guideline working better for patient care
  1. M Khursheed,
  2. K Ejaz,
  3. J Razzak,
  4. U R Khan
  1. Aga Khan University Hospital, Karachi, Sindh, Pakistan

Abstract

Introduction Globally Dengue has threatened to infect 3 billion people. TDR/WHO version launched the latest version of Dengue guidelines recently. In this cross sectional study, we compared clinical diagnosis of patients admitting to the hospital with WHO 1997 and TDR/WHO 2009 guidelines. To also explored strengths and weakness of the two classifications.

Methodology Dengue cases admitted from January 2005 to December 2007 at Aga Khan University Hospital, Pakistan were reviewed. Data were recoded using Dengue grading according to the WHO 1997 and TDR/WHO 2009 guidelines. Correlation among the three sets of disease classifications were tested statistically.

Results TDR/WHO 2009 in comparison to the clinical classification showed that out of 612, 24 (4%) patients did not fulfil the new classification. TDR labelled 124 (20%) patients as having Severe Disease, out of which 118 (95%) were labelled as DF, 3 (2.5%) as DHF and 3 (2.5%) as DSS by the physician. (χ2 18.7, p value 0.005) (Likelihood Ratio 17.9, p value 0.006) Comparing the new guidelines with the old, TDR labels 124 (20%) cases as Severe Disease in comparison to the 24 (4%) by WHO. (χ2 89.8, p value 0.0001) (Likelihood Ratio 92.1, p-value 0.0001) The value of 0.24 of Cramer's V signifies that there is little association between the two classifications.

Conclusion TDR/WHO 2009 dengue guideline is a better version of WHO 1997 guideline as it is able to identify the critical patients early in the disease course. However, this might lead to overestimation of disease severity which can be a restraint for developing nation's resources.

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