Development and Validation of the Dengue Simplified Severity Score Based on the Marois Severity Score for Predicting Severe Dengue in the Emergency Department

Abstract

Objective: To validate and simplify Marois Severity Score (MSS) for improved usability in the emergency department (ED) setting, and to compare its predictive accuracy with a newly developed Dengue Simplified Severity Score (D-SSS). Methods: This retrospective, observational study included adult patients presenting with laboratory-confirmed dengue to Universiti Malaya Medical Centre ED from January 2023 to December 2023. D-SSS was developed by modifying MSS. The scoring system incorporated age, hypertension, mucosal bleeding, thrombocytopenia, and elevated ALT levels. D-SSS and MSS were evaluated for accuracy in predicting severe dengue according to the World Health Organisation 2009 classification using receiver operating characteristic (ROC) analysis. Results: Of 507 eligible patients, 350 were analysed. D-SSS, with a cut-off value of 2.5, demonstrated 80.0% (95% CI: 51.91, 95.67) sensitivity and 75.5% (95% CI: 70.55, 80.03) specificity in predicting severe dengue. Its discriminative ability (AUC: 0.856) was numerically higher but not statistically different from MSS (AUC: 0.782; p = 0.335, DeLong's test). Conclusions: D-SSS provides an accurate and more practical tool for predicting severe dengue in the ED. Its simplified design enhances applicability, facilitating earlier intervention and potentially improving patient outcomes.