Table 1.
PICOS statement.
Table 2.
Traditional (1997) and revised (2009) WHO clinical definitions of dengue fever.
Fig 1.
PRISMA flow diagram for systematic review search results.
AFI: Acute febrile illness. PubMed, EMBASE, Scopus, and OpenGrey were searched for articles assessing the diagnostic accuracy of clinical criteria for dengue diagnosis, Dengue Bulletin articles and short notes were also included. The additional record was identified from previous work but did not mention WHO criteria in the title or abstract. Citation network analysis used Web of Science, Google Scholar, and reference lists. Articles assessing the diagnostic accuracy of unmodified WHO clinical criteria (1997 or 2009) for dengue were included in the meta-analysis, articles using modified criteria were included in qualitative analysis only.
Table 3.
Characteristics of studies included in the systematic review.
Table 4.
Patient flow through studies included in the systematic review.
Fig 2.
Risk of bias analysis for included studies assessing the diagnostic accuracy of clinical criteria for dengue fever.
+ (green): Low risk; +* (green): Withdrawals/indeterminate results not mentioned, assumed none and thus low risk;? (amber): unclear risk;—(red): high risk; CS: cohort study; HS: Hospital study; AN: Aedes Network study; PHS: Public Health Surveillance study. Modified refers to modifications from the 1997 or 2009 WHO criteria. The assessment was carried out by two independent reviewers (NR/SL) using a modified version of QUADAS-2 (S2 Table). A study was deemed to be at high risk of bias if any domain was at high risk of bias.
Fig 3.
Forest plot for sensitivity and specificity of the WHO 1997 case definition for probable dengue.
Meta-analysis carried out in Stata/IC 14 using the MIDAS statistical package. 95% confidence intervals given in parentheses. HS: hospital study; CS: cohort study; AN: Aedes Network Study; PHS: Public Health Surveillance Network Study. a: Calculated specificity differs from the reported value (0.2121); b: Calculated sensitivity differs from the reported value (0.98).
Fig 4.
Forest plot for sensitivity and specificity of the WHO 2009 case definition for probable dengue.
Meta-analysis carried out in Stata/IC 14 using the MIDAS statistical package. 95% confidence intervals given in parentheses. HS: hospital study; CS: cohort study; AN: Aedes Network Study; PHS: Public Health Surveillance Network Study. a: Calculated sensitivity differs from the reported value (0.909).
Table 5.
Sensitivity and specificity from studies that modified WHO clinical criteria for dengue diagnosis.