Seasonal Outbreak of Dengue Fever in Northern India - A Clinical Perspective and Predicting Length of Hospital Stay

Abstract

Aims: India reports frequent outbreaks of dengue fever every year. Scarcity of hospital beds during these outbreaks can be fatal to some. In this study we looked into the clinical and laboratory features of dengue fever in children and predictors of prolonged hospital stay. Study Design: Prospective cross-sectional descriptive study Place and Duration of Study: Department of Pediatrics, Hamdard Institute of Medical Sciences and Research from September to December 2017. Methodology: This prospective study was conducted in admitted patients in the Pediatric department of a teaching hospital in Delhi to determine the clinical and laboratory features of all children admitted with dengue fever and find out any predictive factor for prolonged hospital admission. All clinical and laboratory confirmed dengue cases were included in the study. Patients were divided into dengue fever without warning signs (DF), dengue fever with warning signs (DWS) and severe dengue (SD) as per WHO Classification. Results: Of the 92 cases, 78 had positive IgM ELISA/NS1 Ag, 14 were clinical cases. The M:F is 1.7:1, the mean age is 7+ 4.2 years. The common clinical features were fever (94%), abdominal pain (61%), vomiting (53%) and lethargy (52%). 61% patients were categorised as DWS, 30% as DF and 9% SD. The mean duration of hospital stay was 5 ± 2.8 days. 43% were hospitalised for > 5 days. Prolonged hospital stay (>5days) was significantly associated with high grade fever (>102°F) and lethargy (p<0.05). Conclusion: A high proportion of patients with DWS required hospitalisation. Admission during the critical phase of dengue is essentially life-saving.  For clinical practice, the doctors working in the front line should be aware of the factors significantly prolonging LOS in the management of dengue fever. This can identify the patients at highest risks and help focus time and resources during seasonal outbreaks.