Timothy Gleeson, MD
University of Massachusetts Medical School
“Point of Care Ultrasound to Predict Progression of Dengue Fever”
Academy of Emergency Ultrasound Research Grant
This study is a prospective trial with the purpose to assess the ability of bedside ultrasound findings to predict disease progress in children with presumed dengue fever. The specific aims are to determine the association with sonographic findings in children at the time of presentation to the hospital with fever and suspicion for early dengue fever (intra-thoracic fluid, intra-peritoneal fluid, pericardial effusion, gallbladder wall thickening) and progression to dengue with warning signs and severe dengue (per WHO guidelines). We will also include assessment for sonographic b lines to determine if this may be an early sign of fluid accumulation and predictor of disease progression. This trial will enroll patients at Angkor Hospital for Children (AHC) in Siem Reap, Cambodia during peak dengue season. The research protocol does not involve any deviation from the current standard of care for pediatric dengue fever as practiced by pediatric physicians at AHC and will be a joint effort between our institutions. While there are serologic markers for the flavivirus causing dengue, there is no reliable or specific marker to identify risk of progression from earlier, milder disease to more severe disease. Due to limited space and resources in developing countries, it can be difficult to determine which patient requires admission, observation, or can be safely discharged home. Evidence of plasma leakage has typically been used as an indicator of increasing severity of illness. Clinically, this can be determined using serial hematocrits to diagnose hemoconcentration, thrombocytopenia, or identification of large pleural effusions on chest x-ray. These tests are less useful in developing countries due to limited availability. Subjects will be identified as they present to the emergency department at the AHC. Subjects presenting with fever and presumptive dengue with or without warning signs will be consented and included in the study. Bedside ultrasound (gallbladder, lung, FAST exam) will be performed on each subject and their findings recorded. Subjects will be discharged or admitted based on established clinical guidelines. Admitted patients will be followed to determine progression their disease. Discharged patients will be contacted by telephone to determine disease progression, repeat visits/admission, or death.
Dengue fever is one of the most prevalent mosquito-borne illnesses worldwide and has significant morbidity and mortality. Early/accurate diagnosis is important to management, particularly in resource-limited settings. Point of care ultrasound is increasingly available in resource-limited settings and may be useful in predicting disease progression and determination of need for admission, close follow-up, or safe discharge to home.
Dr. Gleeson is still completing the project.