Affiliations: Department of Paediatrics, King Edward Medical
University/Mayo Hospital, Lahore, Pakistan | Central Park Medical College, Lahore, Pakistan
Note: [] Correspondence: Muhammad Ashraf Sultan, Chairman and Professor,
Department of Paediatrics, King Edward Medical University/Mayo Hospital,
Lahore, Pakistan. Managing Editor, Pakistan Paediatric Journal. E-mail: [email protected]
Abstract: World Health Organization (WHO) clinical case definition for the
diagnosis of measles lacks diagnostic accuracy. We thus propose two separate
scoring criteria for the diagnosis of acute and post measles cases. This study
was conducted to determine the diagnostic accuracy of scoring criteria in
confirmed cases of measles. This cross-sectional validation study was conducted
in the Department of Paediatrics Unit-I, King Edward Medical University,
Lahore, Pakistan, from March-August 2009. Sixty-one cases fulfilling the WHO
clinical case definition of measles were included in the study, and divided
into Group A (Acute measles) and Group B (Post measles). A separate criterion
was used for each. Positive Serology (IgM) was taken as confirmed cases. At
scores ⩾ 3, ⩾ 4 and ⩾ 5, the sensitivity, specificity, positive
predictive value (PPV) and negative predictive values (NPV) were calculated.
Appropriate statistical tests were applied. In Group A, out of 36 cases, 28
(78%) had total score ⩾ 4, whereas IgM was positive in 24 (67%). The
scoring criteria had sensitivity, specificity, PPV and NPV of 100%, 66.7%, 86%
and 100% respectively. In Group B, out of 25 cases, 23 (92%) had a total score
⩾ 4 whereas IgM was positive in 22 (88%) cases. The scoring criteria had
sensitivity, specificity, PPV and NPV of 100%, 66.7%, 96% and 100%
respectively. The measure and strength of association were statistically
significant for both Groups. At scores ⩾ 3 and ⩾ 5, sensitivity,
specificity and predictive values were not statistically significant in either
group. This study has shown that the criteria for the diagnosis of acute and
post measles cases at a score ⩾ 4 are valid to make a clinical diagnosis.
Keywords: Acute measles, measles IgM, post measles, scoring criteria
