# Situation: Dengue cases are being reported in a densely populated barangay during the rainy season. The nurse at the Barangay Health Station (BHS) sees febrile children and works with the barangay officials. For a 9-year-old boy with 2 days of fever, the nurse inflates the blood pressure cuff midway between the systolic and diastolic pressures for 5 minutes. She then counts 6 petechiae in a 2.5 cm × 2.5 cm square on the forearm. How should she interpret this result?

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> subject: Nursing Practice I — Community Health Nursing

## 문제

Situation: Dengue cases are being reported in a densely populated barangay during the rainy season. The nurse at the Barangay Health Station (BHS) sees febrile children and works with the barangay officials.

For a 9-year-old boy with 2 days of fever, the nurse inflates the blood pressure cuff midway between the systolic and diastolic pressures for 5 minutes. She then counts 6 petechiae in a 2.5 cm × 2.5 cm square on the forearm. How should she interpret this result?

## 보기

1. Negative; dengue is ruled out for this illness
2. Negative; dengue remains possible, so he is followed **✔ 정답**
3. Positive; he should have a dengue test done today
4. Positive; dengue is confirmed and he needs admission

**정답: 2**

## 해설

The tourniquet test is read as positive at 20 or more petechiae in a 2.5 cm × 2.5 cm square (some references use 10 or more per square inch), so a count of 6 is negative by either cut-off. The test supports a dengue diagnosis but is not specific or sensitive enough to confirm or exclude it, so the child is still monitored for fever and warning signs.

## 심화 해설

Interpreting the Tourniquet Test Result

The nurse counted 6 petechiae in a 2.5 cm × 2.5 cm square. The standard cut-off for a positive tourniquet test is 20 or more petechiae in that same area, although some references accept 10 or more per square inch as an alternative threshold. A count of 6 falls below both cut-offs, so the result is negative.

However, a negative tourniquet test does **not** rule out dengue. The test reflects capillary fragility and thrombocytopenia, which are not present in every dengue case, especially early in the illness. The boy has only had fever for 2 days, and capillary leakage may not yet be pronounced. The tourniquet test supports a dengue diagnosis when positive, but its low sensitivity means a negative result cannot exclude dengue.

Watch out! A positive tourniquet test is not confirmatory for dengue either. Other conditions causing capillary fragility or thrombocytopenia—such as scrub typhus, Epstein-Barr virus infection, or other viral illnesses—can also produce petechiae. The test is a bedside screening aid, not a definitive diagnostic tool.

The large Brazilian analysis of 28,000 tourniquet test trials found that the test has low sensitivity for differentiating dengue from other febrile illnesses [1]. This means many true dengue cases will have a negative tourniquet test. Similarly, a study among Lao adults with suspected dengue found that the admission tourniquet test alone was insufficient to confirm or exclude dengue; serological testing was required [2]. The Rumpel-Leede phenomenon—petechiae appearing distal to a cuff—can occur with any condition that increases capillary fragility, not just dengue [3].

Because the tourniquet test is neither sensitive nor specific enough to confirm or exclude dengue, a negative result in a febrile child from an endemic area still requires close follow-up. The nurse should monitor the boy for continued fever, warning signs (abdominal pain, persistent vomiting, mucosal bleeding, lethargy), and arrange appropriate dengue testing if clinically indicated.

Key point! The tourniquet test result of 6 petechiae is negative by standard cut-offs, but dengue remains possible. The child should be followed for fever progression and warning signs rather than being discharged from care.References (research sources)

- [1]Low sensitivity of the tourniquet test for differential diagnosis of dengue: an analysis of 28,000 trials in patientsResearch articleNathália Barbosa Furlan, Caroline Tukasan, Cássia Fernanda Estofolete, Maurício Lacerda Nogueira, Natal Santos da Silva (2016) · DOI: 10.1186/s12879-016-1947-7

- [2]Predictive diagnostic value of the tourniquet test for the diagnosis of dengue infection in adultsResearch articleMayfong Mayxay, Rattanaphone Phetsouvanh, Catrin E. Moore, Vilada Chansamouth, Manivanh Vongsouvath, Syho Sisouphone (2010) · DOI: 10.1111/j.1365-3156.2010.02641.x

- [3]Rumpel-Leede Phenomenon Secondary to Acute Epstein-Barr Virus Infection in a Young AdultResearch articleMiguel Cervantes, Alexandre Cervantes, Disha Hayagreev, Pawel Chomicki (2025) · DOI: 10.7759/cureus.97986

## 임상 시나리오

Tourniquet Test Interpretation in Suspected DengueBedside screening and clinical follow-up
A positive result requires 20 or more petechiae in a 2.5 cm × 2.5 cm square. A count of 6 is therefore negative.

A negative result does not rule out dengue. The test has low sensitivity, particularly during the first 2–3 days of fever before capillary leakage peaks.

CautionContinue monitoring the child for fever pattern and dengue warning signs such as persistent vomiting, abdominal pain, mucosal bleeding, or lethargy. A negative test is not a discharge criterion.

## 핵심 개념

- **Tourniquet Test** — A bedside capillary fragility test where a blood pressure cuff is inflated midway between systolic and diastolic pressures for 5 minutes; positive if 20 or more petechiae appear in a 2.5 cm x 2.5 cm square.
- **Petechiae** — Pinpoint, non-blanching red or purple spots on the skin caused by minor hemorrhage from broken capillary blood vessels.
- **Capillary Fragility** — A condition where small blood vessels are easily damaged, often associated with thrombocytopenia in dengue infection.
- **Dengue Warning Signs** — Clinical indicators such as persistent vomiting, abdominal pain, mucosal bleeding, or lethargy that signal a higher risk of severe dengue.
- **Sensitivity** — The ability of a test to correctly identify those with a disease; the tourniquet test has low sensitivity for dengue.

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