Brogan and Raffles reported criteria that can help to evaluate a pediatric patient with fever and petechiciae. These can help guide appropriate management. The authors are from Queen Elizabeth II Hospital in England.

Patient selection: pediatric patient from 2 months to 16 years of age with petechial rash and peripheral temperature > 37.4°C (99.4°F). Petechiae were defined as pinpoint bruising of the skin < 2 mm in diameter.


Outcome: significant bacterial sepsis (SBS)


The prevalence of SBS in the study population was 9%. Diagnoses other than SBS included: Henoch-Schonlein purpura, ITP, trauma, allergy, and viral infection.


"ILL" criteria for SBS:

(1) irritability (I): inconsolable crying or screaming

(2) lethargy (L)

(3) low capillary refill (L): refill time > 2 seconds


Additional laboratory findings:

(4) leukopenia or leukocytosis (L): WBC count < 4,000 per µL or > 15,000 per µL

(5) serum CRP > 5 mg/L ("elevated")



• Some reference ranges for CRP go to 10 mg/L as the upper limit of normal.

• The authors note that a child presenting soon after symptom onset (less than 12 hours) may not show an elevated serum CRP.


Clinical Findings

Laboratory Findings




Observation for 4 hours, then reassess. If no deterioration then manage as an outpatient (provided child can be brought back promptly if there is deterioration).


one or both

Treat with antibiotic pending blood cultures. May designate as "suspected" meningococcemia.

one or more

one or both

Treat as meningococcemia. Consider admission to ICU.


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