•    HOME   
•    NEWS   
•    BUSINESS   
•    INTERNATIONAL   
•    TECH   
•    SPORTS   
•    LIFE & TIMES   
•    OPINION   
•    MY JAKARTA   
•    BLOGS   
•    EYEWITNESS   

Singapore. It will soon be much easier for general practitioners to sort out high-risk from low-risk dengue cases, which means most patients need not be warded.

The game changer is a "decision chart" developed by Tan Tock Seng Hospital (TTSH) which specifies all the critical symptoms of patients who are more likely to develop the high-risk dengue hemorrhagic fever (DHF), in which uncontrollable bleeding occurs, leading to higher risk of death.

It also means less severely ill patients can avoid unnecessary hospitalization costs and more hospital beds can be freed up.

Resources can then be channeled to monitoring the severe cases.

Deciding whether to ward patients or treat cases as outpatients has so far been based on doctors' judgment, said Associate Professor Leo Yee Sin, clinical director of the Communicable Disease Centre at TTSH.

Based on an ongoing survey of GPs by the hospital, more than 85 per cent of the 300-plus respondents carry out a blood test to diagnose and monitor patients suspected of having dengue.

But this tests only for red and white blood cell count. “The test has to be fine-tuned to include other indicators like gum or nose bleeds and blood protein and urea levels to accurately predict if a case is severe,” Leo said.

For instance, if a patient with fever also has bleeding gums or nose, low blood protein and high urea content, he should be warded. Otherwise, outpatient treatment suffices.

Leo believes the decision chart TTSH plans to circulate among GPs will “augment” their current practice.

She spoke to the media yesterday before marking the inaugural Asean Dengue Day at the hospital to raise awareness about effectively tackling dengue.

The chart is derived from a sophisticated software, the DHF calculator, which the hospital has used since mid-2007.

The TTSH-developed calculator, based on historical data of the hospital's warded patients, accurately predicts severity based on four indicators: bleeding gums or noses, white blood cell count, blood protein level and urea level.

From drawing of a patient's blood to getting the laboratory test results into the software, a decision can be made within two hours on whether the patient needs to be warded.

Previously, TTSH warded 80 per cent of its dengue patients, which Leo said “is not sustainable” in an epidemic. Since it started using the calculator, admissions have fallen to 40 per cent.

“The calculator is designed to be sensitive so we don't miss out any individual whose condition may worsen. Even then, we still manage to cut our admission rate by half,” she said.

The last major dengue outbreak in Singapore was in 2005, when it hit 14,209 people and killed 25.

Last year, more than 5,300 cases were reported, while the first five months of this year saw 1,600 cases.

No vaccination against dengue fever is available, but one is expected in five years. Worldwide, the disease affects 55 per cent of the population, with 75 per cent of the cases in the Asia-Pacific.


Reprinted courtesy of Straits Times Indonesia. To subscribe to Straits Times Indonesia and/or the Jakarta Globe call 021 2553 5055