Avaliação da confiabilidade do diagnóstico clínico: epidemiológico da dengue e em área São José do Rio Preto

Abstract

In Brazil, Dengue is one of the main infectious diseases and a growing public health issue. It is a disorder with unspecified signs and symptoms whose varied spectrum of clinical manifestations provide, in most cases, the need to use laboratory tests to confirm the clinical diagnosis. With the growing number of people infected each year and the significant increase in people at risk of dengue, it is important to point out effective practices of diagnosis and treatment. Objective: The objective of this study is to access the accuracy of clinical diagnosis of Dengue by analyzing an area endemic to dengue. Material and Method: A total of 148,299 cases were assessed. The sensitivity, specificity, positive and negative predictive value (PPV and NPV) of the patients' demographic and clinical characteristics were compared to a diagnosis of dengue in laboratory. We measured the association between these variables and positive laboratory tests for dengue. Logistic regression assessed the probability of dengue related signs and symptoms being present in clinical and laboratory diagnosis. Results: When analyzing signs and symptoms of Dengue, we have found great variability on sensitivity, ranging from 0.8% to 81.1%; on specificity, ranging from 21.5% to 99.6%; as well as in the analyses for PPV 92.0% and NPV 42.0%.Conclusions: Considering the results obtained in the study, for higher accuracy, the clinical and laboratory diagnosis of Dengue should be performed simultaneously. When laboratory tests are not available, we suggest concentrating on the clinical manifestations most commonly associated with Dengue.