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")
where:
• 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.
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Clinical Findings
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Laboratory Findings
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Management
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none
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none
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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).
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none
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one or both
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Treat with antibiotic pending blood cultures. May designate as "suspected" meningococcemia.
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one or more
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one or both
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Treat as meningococcemia. Consider admission to ICU.
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