From the Guidelines
Patients with dengue fever should be admitted to the hospital if they show warning signs of severe disease, such as severe Dengue shock syndrome, or have high-risk factors. The admission criteria for patients with dengue fever include severe abdominal pain, mucosal bleeding, lethargy or restlessness, liver enlargement, laboratory evidence of increasing hematocrit with decreasing platelets, or clinical fluid accumulation 1. High-risk patients who should be considered for admission include those with severe Dengue shock syndrome, characterized by a pulse pressure of less than 10 mmHg, as they may benefit from colloid solutions for fluid resuscitation 1. Other high-risk factors for admission include pregnancy, infancy, elderly age, comorbidities such as diabetes, hypertension, obesity, or kidney disease, and social circumstances that prevent adequate monitoring. Patients with severe dengue manifestations, such as severe plasma leakage leading to shock or respiratory distress, severe bleeding, or severe organ impairment, require immediate hospitalization. Key considerations for admission include the potential for rapid progression to life-threatening complications during the critical phase of the illness, the need for close monitoring, and timely fluid management, which is the cornerstone of dengue treatment 1. In resource-limited settings, crystalloid solutions are recommended as the first-line fluid for resuscitation, with colloids considered for children with severe Dengue shock syndrome 1. The use of dopamine or epinephrine may be considered in patients with persistent tissue hypoperfusion despite fluid resuscitation, with frequent monitoring of arterial blood pressure and heart rate 1. Intravenous hydrocortisone or prednisolone may be administered to adult patients requiring escalating dosages of epinephrine or dopamine, and considered in children with severe shock 1. Overall, the admission criteria prioritize patients at high risk of severe disease or complications, and emphasize the importance of close monitoring and timely intervention to prevent morbidity and mortality. Some key points to consider when deciding on admission include:
- Severe Dengue shock syndrome, characterized by a pulse pressure of less than 10 mmHg
- High-risk factors, such as pregnancy, infancy, elderly age, or comorbidities
- Severe dengue manifestations, such as severe plasma leakage, severe bleeding, or severe organ impairment
- The need for close monitoring and timely fluid management
- The potential for rapid progression to life-threatening complications during the critical phase of the illness.
From the Research
Admission Criteria for Patients with Dengue Fever
The admission criteria for patients with dengue fever are based on the severity of the disease and the presence of warning signs. According to the World Health Organization (WHO) guidelines, patients with any warning sign can be hospitalized for observation and management 2. The warning signs include:
- Abdominal pain
- Persistent vomiting
- Fluid accumulation
- Mucosal bleeding
- Lethargy
- Liver enlargement
- Increasing haematocrit and thrombocytopenia
Severity of Dengue Fever
The severity of dengue fever is classified into three categories:
- Without warning signs
- With warning signs
- Severe dengue with severe plasma leakage, severe bleeding or organ failure 3
Admission Criteria Based on Severity
Patients with severe dengue or those who are at risk of developing severe disease should be admitted to the hospital for close monitoring and management. This includes patients with:
- Shock or unstable vital signs 4
- Severe bleeding or plasma leakage
- Organ failure, such as acute kidney injury or acute liver failure 3
- Warning signs, such as abdominal pain, persistent vomiting, or mucosal bleeding 2
Laboratory Criteria for Admission
Laboratory criteria, such as a low platelet count or elevated hematocrit, can also be used to guide admission decisions. For example, a platelet count below 100 × 10^9/L or a hematocrit above 20% can indicate an increased risk of severe disease 5.
Clinical Judgment
Ultimately, the decision to admit a patient with dengue fever should be based on clinical judgment, taking into account the patient's overall condition, laboratory results, and the presence of warning signs. Patients who are at high risk of developing severe disease or those who require close monitoring and management should be admitted to the hospital 6.