The accuracy of newly proposed warning signs in the third edition of Malaysian guideline on the management of dengue infection in adult

Objective:To evaluate the accuracy of persistent vomiting and persistent diarrhoea proposed in the Malaysian dengue guideline.Methods:The eligibility criteria were dengue patients with vomiting or/and diarrhoea at the earliest day of illness without other warning signs.Vomiting and diarrhoea categorised by three or more episodes over 24 h were considered as warning signs.Sensitivity,specificity,positive predictive value and negative predictive value were calculated.Results:There were a total of 479 patients,of whom 36(7.5%)got severe dengue and 443(92.5%)got dengue with warning signs.The overall accuracy ranged from 33.3%to 72.7%for sensitivity,28.8%to 56.5%for specificity,1.8%to 14.5%for positive predictive value and 88.5%to 96.3%for negative predictive value.There were 16 false negative.Conclusions:The newly proposed warning signs in the third edition of Malaysian dengue guideline may not be effective in predicting severe dengue.