Accuracy of dengue clinical diagnosis with and without NS1 antigen rapid test: Comparison between human and Bayesian network model decision

PLoS Negl Trop Dis. 2018 Jun 18;12(6):e0006573. doi: 10.1371/journal.pntd.0006573. eCollection 2018 Jun.

Abstract

Differentiating dengue patients from other acute febrile illness patients is a great challenge among physicians. Several dengue diagnosis methods are recommended by WHO. The application of specific laboratory tests is still limited due to high cost, lack of equipment, and uncertain validity. Therefore, clinical diagnosis remains a common practice especially in resource limited settings. Bayesian networks have been shown to be a useful tool for diagnostic decision support. This study aimed to construct Bayesian network models using basic demographic, clinical, and laboratory profiles of acute febrile illness patients to diagnose dengue. Data of 397 acute undifferentiated febrile illness patients who visited the fever clinic of the Bangkok Hospital for Tropical Diseases, Thailand, were used for model construction and validation. The two best final models were selected: one with and one without NS1 rapid test result. The diagnostic accuracy of the models was compared with that of physicians on the same set of patients. The Bayesian network models provided good diagnostic accuracy of dengue infection, with ROC AUC of 0.80 and 0.75 for models with and without NS1 rapid test result, respectively. The models had approximately 80% specificity and 70% sensitivity, similar to the diagnostic accuracy of the hospital's fellows in infectious disease. Including information on NS1 rapid test improved the specificity, but reduced the sensitivity, both in model and physician diagnoses. The Bayesian network model developed in this study could be useful to assist physicians in diagnosing dengue, particularly in regions where experienced physicians and laboratory confirmation tests are limited.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Bayes Theorem
  • Dengue / diagnosis*
  • Dengue / virology
  • Female
  • Fever / diagnosis*
  • Fever / virology
  • Humans
  • Immunologic Tests
  • Male
  • Middle Aged
  • Predictive Value of Tests
  • Sensitivity and Specificity
  • Thailand
  • Viral Nonstructural Proteins / immunology*
  • Young Adult

Substances

  • Viral Nonstructural Proteins

Grants and funding

This study was supported by Research Fund from the Faculty of Tropical Medicine, Fiscal Year 2012 and Dean’s Research Fund 2012, the Faculty of Tropical Medicine, Mahidol University. PH was partially supported through a fellowship from the Hanse-Wissenschaftskolleg Institute for Advanced Study, Delmenhorst, Germany. The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.