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
