Score of Nielsen et al for Meningococcemia in a Child with Hemorrhagic Rash and Fever

 

Patient selection: pediatric patient with hemorrhagic rash and fever

 

Parameters:

(1) nuchal rigidity

(2) general conditions score of Nielsen et al (from 3 to 9)

(3) maximum diameter of a hemorrhagic lesion in mm

(4) universal distribution

(5) type of skin hemorrhages

 

Parameter	Finding	Points
nuchal rigidity	absent	0
	present	1
general condition score	7, 8 or 9	0
	3 to 6	1
maximum diameter	<= 2 mm	0
	> 2 mm	1
universal distribution	no	0
	yes	1
type of skin hemorrhage	micropetechiae, regular ecchymosis	0
	large petechiae, irregular lesion with multiple points, central lesion surrounded by less intense rime	1

 

total score =

= SUM(points for all 5 parameters)

 

Interpretation:

• minimum score: 0

• maximum score: 5

• A score >= 2 is associated with meningococcemia.

• A child with a negative score at presentation may show a positive screen if it is performed on follow-up.

 

Laboratory findings supporting the diagnosis of meningococcemia:

(1) absolute band count > 500 per µL (odds ratio 38.3)

(2) CRP > 68 mg/L (odds ratio 12.4)

 

Performance:

• 97% of children with meningococcemia were identified.

• The false positive rate was 12%.