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ORIGINAL ARTICLE
Year : 2017  |  Volume : 15  |  Issue : 2  |  Page : 121-124

Validation of a clinical score to differentiate scrub typhus and dengue


1 Department of Emergency Medicine, Christian Medical College, Vellore, Tamil Nadu, India
2 Department of General Medicine, Christian Medical College, Vellore, Tamil Nadu, India
3 Department of Biostatistics, Christian Medical College, Vellore, Tamil Nadu, India

Correspondence Address:
Kundavaram Paul Prabhakar Abhilash
Department of Emergency Medicine, Christian Medical College, Vellore - 632 004, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/cmi.cmi_18_17

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Background: Scrub typhus and dengue are two major causes of acute undifferentiated febrile illness in many parts of India and are difficult to differentiate at initial presentation. Materials and Methods: This retrospective observational study was conducted in a large emergency department (ED) between September 2014 and December 2014. The clinical score to differentiate scrub typhus and dengue (CSSD) was validated on confirmed cases of scrub typhus and dengue who presented during the study period. The six variables used in CSSD were SpO2, hemoglobin, total white blood cell count, serum glutamic oxaloacetic transaminase level, serum bilirubin, and sensorium. Results: During the study period, 134 confirmed cases of scrub typhus and dengue were included in the analysis, of which 68 were scrub typhus and 66 were dengue. A male predominance was seen in dengue (60.6%), whereas females comprised the majority in scrub typhus (58.8%). Among 68 confirmed cases of scrub typhus, 32 patients have CSSD score <13, favoring scrub typhus. Among 66 confirmed cases of dengue, 64 patients have CSSD score ≥13, favoring dengue. CSSD has high specificity (97%) and positive predictive value (94%) for scrub typhus patients. CSSD score has high sensitivity (97%) and negative predictive value (94%) for dengue patients. Conclusion: The CSSD is a simple and inexpensive score that can be done rapidly at initial presentation of the patient to the ED. It has a high specificity and positive predictive value for scrub typhus and high sensitivity and negative predictive value for dengue and can be used to differentiate scrub typhus and dengue within a few hours of presentation to the hospital.


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