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.