Abstract
Dengue is an important cause of systemic febrile illness among international travelers. Because signs and symptoms are similar to other infectious illnesses, dengue may not be promptly considered when patients seek care. We conducted a retrospective cohort study of patients diagnosed with dengue in the United States from 2001 to 2021 using the Merative MarketScan Research databases, a large collection of health insurance records. We identified patients diagnosed with dengue and enrolled ≥180 days before diagnosis. We then compared the frequency of visits with signs/symptoms compatible with dengue during the 14 days before diagnosis with a control period 15-180 days before diagnosis. We conducted a bootstrap-based analysis to estimate duration, frequency, and potential risk factors for missed diagnostic opportunities. We identified 5,992 cases of dengue. We found that 3,090 (51.6%) patients had one or more health care visits before diagnosis with characteristic signs/symptoms of dengue recorded. We estimated that 22.8% (95% CI: 21.3-24.4) experienced one or more missed opportunities for diagnosis, and the average duration of diagnostic delay was 4.02 (95% CI: 3.67-4.43) days. Potential missed diagnostic opportunities were less likely to occur at visits with an infectious disease consult but were more likely to occur during weekend visits and visits involving an antibiotic or opioid prescription. Diagnostic delays for dengue may be common, with almost a quarter of patients in our sample potentially experiencing a missed diagnostic opportunity. Future work should aim to improve timeliness of diagnosis and identify patient populations at greatest risk for delay.