Abstract
Clinical Presentation of Dengue Among Patients Admitted to the Adult Emergency Department of a Tertiary Care Hospital in Martinique: Implications for Triage, Management, and Reporting
Dengue fever (DF) is a mosquito-borne viral infection with clinical presentations ranging from uncomplicated illness to more severe signs such as plasma leakage, bleeding, and acute organ failure. During DF epidemics, medical providers evaluate many patients with acute febrile illness and would benefit from triage algorithms to improve patient care and resource utilization. This study enrolled 715 patients with febrile illness and a confirmed diagnosis of DF in Martinique, a French Caribbean island, from 2005 to 2010. The study population was retrospectively classified based on clinical presentation to the emergency department to develop a more effective triage system during DF epidemics.
Based on clinical presentation, vital signs, blood analysis, and viral serotyping, patients were categorized into uncomplicated DF (54.6%), plasma leakage (14.3%), DF with acute organ failure (4.6%), and DF with dehydration (23.9%). A secondary infection by any of the 4 serotypes identified or DENV-2 serotype alone was the most severe presentation. Hospital admission was required for 26.9% of the patients, with an average length of stay equivalent to 4 days. Patients diagnosed with “dengue fever with dehydration” had a dramatic improvement after saline rehydration and were discharged within 24 hours. The authors strongly recommended saline infusion as a treatment modality. Limitations of the study include the use of 1 emergency department, a variable initial clinical presentation, and limited application to a pediatric population. The authors concluded that an effective triage system for patients with suspected DF must evaluate for signs of shock and plasma leakage, followed by aggressive intravenous fluid and electrolyte replacement.
(Ann Emerg Med. 2012;59:42–50). L Thomas, V Moravie, F Besnier, et al
Prepared by Matthew Stewart, MD, University of Utah Emergency Medicine Resident, Salt Lake City, UT, USA