Development and Validation of a Bedside Dengue Severity Score for Predicting Severe Dengue in Children

Objective: To develop and validate a bedside dengue severity score in children less than 12 years for predicting severe dengue disease. Methods: We carried out an analysis of data on the clinical and laboratory parameters of patients with confirmed dengue, hospitalized in October, 2019 at our center. A comprehensive patient’s score was developed. Predictive models for severity were built using a forward step-wise method. This model was validated on the data of 312 children with dengue admitted during September- October, 2021. Results: Severe dengue was predicted by the dengue severity score with a sensitivity of 86.75% (95% CI 77.52%-93.19%), specificity of 98.25% (95% CI 95.56-99.52%), a positive predictive value of 95.34% (95% CI 92.18%-97.26%) and a negative predictive value of 94.74% (95% CI 87.16%-97.95%). The overall predictive accuracy was 95.2% (95% CI 92.19%- 97.28%). Conclusion: The proposed bedside dengue severity scoring system was found to have good validity. Validating the score in different settings and patient populations is suggested.

Etiology of Hemoptysis in Children and Adolescents – Multicentric Retrospective Data (2012-2021) From Chennai

Objective: To analyze the etiology of hemoptysis in children and to correlate the severity of bleed with the etiology. Methods: This retrospective multicentre study reviewed data from inpatient units of four tertiary care public and private sector pediatric hospitals in Tamil Nadu. Methods: Inpatient case records of children (aged 2 month-15 years) treated for hemoptysis at the four institutions between April, 2012 and March, 2021 were identified, after ethical clearance from respective institutions. Data of children with underlying known bleeding disorders like hemophilia or platelet abnormality were excluded from the study. Hemoptysis was categorized as mild, moderate and severe Results: Of the 73 children who had presented with hemoptysis during the study period, 60 (82.2%) children had mild, 9 (12.3%) had moderate and rest had severe hemoptysis. Idiopathic pulmonary hemorrhage was the most common cause of hemoptysis. The common causes of mild hemoptysis in children were idiopathic pulmonary hemorrhage (n=15, 25%), pulmonary tuberculosis (n=12, 20%) and pneumonia (n=8, 13.3%). Congenital airway anomalies and vascular anomalies were more likely to present with moderate to severe bleed. Conclusion: Etiology of hemoptysis is broad and categorizing them into mild, moderate and severe may give a clue about the possible etiology, there by restricting to the required investigations.

Adult Form of Scimitar Syndrome Presenting as Severe Pulmonary Hypertension in a Child.

Background: Scimitar syndrome is a rare association of congenital cardiopulmonary anomalies; the adult form is not usually is associated with pulmonary hypertension. Case characteristics: 6-year-old girl with recurrent episodes of cough and breathlessness, along with features of right heart enlargement. Computed tomography angiogram revealed right pulmonary veins draining into inferior vena cava with dextroposition of heart. Outcome: Successfully managed with surgical correction. Message: Scimitar syndrome should be considered in any child with unexplained pulmonary hypertension and dextroposed heart.