The tourniquet test (TT) is a physical examination maneuver often performed on patients suspected of having dengue. It has been incorporated into dengue diagnostic guidelines and is used in clinical studies. However, little is known about TT performance characteristics in different patient types or epidemiologic conditions. In the dengue-endemic city of Iquitos, Peru, we performed TTs and dengue laboratory assays on 13,548 persons with febrile disease, recruited through either active (n = 1,095) or passive (n = 12,453) surveillance. The sensitivity was 52% and 56%, the specificity was 58% and 68%, the positive predictive value was 45% and 55%, and the negative predictive value was 64% and 69% for persons enrolled in active and passive surveillance, respectively. We demonstrated that the TT was more sensitive identifying dengue disease in women and those of younger age and that sensitivity increased the later a person came to a medical clinic for care.