The Newcastle-Birmingham-Liverpool (NBL) algorithm can be used to manage a child with fever and a non-blanching petechial rash.

Patient selection: pediatric patient with fever and petechial rash


Diagnostic testing to consider include:

(1) complete blood cell count with platelet and white blood cell count

(2) coagulation tests

(3) C-reactive protein (CRP)

(4) blood culture prior to antibiotic administration


Reasons to treat the child as meningococcal disease:

(1) presence of purpura (lesions > 3 mm)

(2) progressive rash

(3) meningism

(4) capillary refill > 5 seconds

(5) respiratory rate > 40 breaths per second

(6) lethargy

(7) irritability


A mechanical cause should be considered if:

(1) there is a history of trauma

(2) distribution of the superior vena cava and history of cough or vomiting


Reasons to consider discharge after an observation period of 4-6 hours:

(1) no purpura

(2) appears well

(3) rash nonprogressive

(4) white blood cell count 5,000 to 15,000 per microliter


Reasons to admit:

(1) suspicion of meningococcal disease

(2) does not meet criteria for discharge

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