Utility of Clinical Improvement and Platelet Count Recovery Time in Counseling Children Hospitalized With Suspected Dengue in A Resource-Poor Setting
Dr Pankaj Garg B-342, Sarita Vihar New Delhi-110076(India)Ph:91-11-40540110,91 9811062793,E-mail: firstname.lastname@example.org
Objective:We aimed to evaluate the utility of platelet count recovery time in children with suspected dengue, altered by interventions such as platelet transfusions, diagnostic groups and lowest platelet counts, in counseling and discharge planning. We also evaluated the usefulness of improvement in clinical signs and symptoms for discharge planning.
Methodology: Baseline data was collected from 41 consecutive hospitalized children who were suspected to be suffering from dengue, during the recent confirmed dengue epidemic in North India (Sep-Nov 2006). All children were managed with standardized guidelines suggested by the World Health Organization (WHO), and time taken for the recovery of platelet counts (>100,000/cumm) was recorded.
Results: The median recovery time(that is the time at which 50% of children had recovered) was noted to be 3 and 4 days respectively, for groups Dengue and Dengue haemorrhagic fever (all grades), using Kaplan-Meier survival analysis (p=0.003). One way analysis of variance showed the two groups to be different, with regards to platelet count recovery time (p=0.004). Duration of hospitalization correlated strongly with the platelet count recovery time (r=0.82, p<0.0001). The lowest levels of platelet count during the course of hospitalization predicted platelet count recovery time (p=0.003). There was fair to moderate agreement (kappa = 0.31-0.5) for improvement in clinical symptoms and signs at the time of discharge, except for a convalescent rash (kappa=0.7).
Conclusion: The information derived from this study is useful for counseling and discharge planning of hospitalized children suspected to be suffering from dengue, during epidemics in the countries of South Asia where people have to make significant out-of-pocket payments.