To the Editor:
We read the publication on “Daily Dengue Severity Score to Assess Severe Manifestations” with a great interest.1 Tangnararatchakit et al noted that “Daily dengue severity score of ≥12 was an accurate assessment tool for severe manifestations.”1 We would like to share ideas on this report. First, the observed sensitivity and specificity of the dengue severity score are not high. The clinical outcomes also depend on several factors such as quality of patient care. In addition, there is also a possibility of variation in each parameter for scoring that can affect the final score. The validation of score in a larger study is required for conclusion on the acceptability of the scoring system.2 Finally, the concurrent infection is not uncommon in endemic area of dengue and it is usually under-recognized.3 In that case, the diagnostic property of scoring system has to be checked. In the present article, it is not possible to verify whether the patient has no concurrent infection.
1. Tangnararatchakit K, Chuansumrit A, Watcharakuldilok P, et al. Daily dengue severity score to assess severe manifestations. Pediatr Infect Dis J. 2019. [Epub ahead of print]
2. Pongpan S, Wisitwong A, Tawichasri C, et al. Development of dengue infection severity score. ISRN Pediatr. 2013;2013:845876.
3. Wiwanitkit V. Dengue fever: diagnosis and treatment. Expert Rev Anti Infect Ther. 2010;8:841–845.