Adherence to the 2016 PAHO Clinical Practice Guideline on Dengue in a Hospital in Northern Peru, 2022-2023
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Background
Effective dengue management enhances the chances of survival. The level of adherence to the suggestions in northern Peru is uncertain. The primary aim of the study was to assess adherence to the 2016 PAHO guideline on dengue in a hospital located in northern Peru during the period from 2022 to 2023.
Methodology/principal findings
The study performed a cross-sectional design and exploratory analysis, reviewing 141 medical records. Fifty-four percent were from 2023; 65.9% were from women; 46.1% came from another healthcare center; 76.6% had diagnosis of dengue with warning signs; 20.7% had severe dengue; and 18.44% died. We found at least one error in the classification of severity and/or treatment in non-hospital healthcare facilities (91.5%), triage (88.5%), and uviclin/observation (52.6%). Errors in classification and inadequate hydration in the non-hospital healthcare centers, triage, and uviclin/observation were: 35.8%/53.7%, 30.6%/76.6%, and 10.1%/45.6%, respectively. Persistent errors were inadequate hydration in triage (76.86%) and urinary flow in the center (73.13%). In a bivariate analysis, mortality was associated with older age (p = 0.035), having a case from 2023 (p = 0.0073), having a case from the study hospital (p = 0.083), and having severe dengue (p<0.001). In the multivariate analysis, only severe dengue (OR 318.4, 95% IC [33.8-2996], p<0.001) was associated with mortality.
Conclusions/significance
We found a high frequency of misclassification and management errors in these three scenarios, but they were not associated with higher mortality.
Author summary
According to the PAHO 2016 Dengue Guidelines, this descriptive study found deficiencies in the diagnosis of severity and treatment in a public hospital of the Ministry of Health of Peru, located in the region with the highest dengue incidence rate in 2023. We identified these deficiencies in the pre-hospital phase, as well as in the emergency, observation, and dengue management units, which had a high mortality rate of 18%. While it is true that management errors were not associated with higher mortality in the exploratory analysis, study biases may explain this result. We must take these findings into account when investigating the effectiveness of the health worker training that took place between 2023 and 2024, employing a master-class methodology and awaiting a before and after analysis to gauge its impact on knowledge. The need for improvements in health data management highlights the need to digitize information and electronic health records.
