Frequency and pattern of WHO warning signs among patients with dengue fever admitted to Mufti Mehmood Memorial Teaching Hospital, Dera Ismail Khan, Pakistan: a hospital-based cross-sectional study
DOI:
https://doi.org/10.59736/IJP.24.03.1136Keywords:
Dengue Fever, Hepatomegaly, Lethargy, Severe dengue, VomitingAbstract
Background: Dengue is an emerging mosquito-borne viral infection. Clinical deterioration is often seen around defervescence, and the World Health Organization (WHO) warning-sign framework is designed to identify the patient who is deteriorating and needs closer monitoring and timely treatment. The study determined the frequency and pattern of recorded WHO warning signs among patients admitted with dengue fever to Mufti Mehmood Memorial Teaching Hospital, Dera Ismail Khan, and explored their distribution across recorded dengue severity categories.
Methods: This hospital-based cross-sectional record analysis included 384 admissions aged 15–60 years. Demographic variables, previous dengue exposure, six recorded warning signs, platelet count, hematocrit, WHO classification, and discharge outcome were analyzed. Frequencies were reported with Wilson 95% confidence intervals (CIs).
Results: Of 384 records, 270 (70.3%) were classified as dengue with warning signs, 79 (20.6%) as dengue without warning signs, and 35 (9.1%) as severe dengue. At least one recorded warning sign was present in 305 patients (79.4%; 95% CI 75.1–83.2). Persistent vomiting was the most frequent warning sign (197; 51.3%), followed by lethargy (97; 25.3%), hepatomegaly (85; 22.1%), abdominal pain (74; 19.3%), mucosal bleeding (18; 4.7%), and clinical fluid accumulation (16; 4.2%). Patients classified as severe dengue had a median of 3 warning signs (IQR 3–3), compared with 1 (IQR 1–2) among those with dengue with warning signs. Overall, 368 patients (95.8%) were discharged, 14 (3.6%) were referred, and 2 (0.5%) died.
Conclusion: Warning signs were recorded in approximately four-fifths of admissions, and persistent vomiting was the predominant manifestation. A structured warning-sign checklist may support triage and serial clinical reassessment, but individual warning signs should not be interpreted in isolation. Prospective validation using verified clinical records, serial hematocrit platelet measurements, and independently adjudicated severe-dengue outcomes is required.
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