Accuracy test of clinical trials for the differential diagnosis of dengue in the pediatric population.
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Abstract
Background: Dengue is a public health problem with a growing incidence, whereby it has emerged as a dare the implementation of a differential diagnosis based on clinical symptoms and signs and clinical laboratory test, for the most affected: pediatric population. Objective: To determine the diagnostic validity of clinical tests for the differential diagnosis of dengue in the pediatric population. Methods: A systematic review of the literature was carried out, including primary studies of dengue diagnostic tests, in the pediatric population. Searches were conducted in MEDLINE-PUBMED, EMBASE, COCHRANE, and LILACS databases. The quality of the studies was evaluated with the QUADAS-2 tool. Register PROSPERO: CRD42019125201. Results: Three studies from Taiwan, Puerto Rico, and Cambodia that met the inclusion criteria were included, although with significant methodological heterogeneity. The index test consists of various combinations of symptoms and signs associated with fever to diagnose dengue. Rash had sensitivity between 27.8 % to 76.1 % and specificity between 55.4 to 95.5 %, with a PPV between 76.7 and 86.1 % that increased to 100 % in various combinations of symptoms and signs. The combination leukopenia, thrombocytopenia, and transaminase elevation had a PPV of 100 %. Conclusion: The varied combination of confirmatory tests affects each configured gold standard's operational characteristics, thus preventing their comparison. The combination of [rash + pruritus + petechiae] suggests the possibility of building a diagnostic algorithm. Insufficient evidence indicates the need to develop standardized prospective clinical evaluation studies based on diagnostic validity of symptoms and signs for differential diagnosis of dengue.
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