European study confirms the combination of fever and petechial rash as an important warning sign for childhood sepsis and meningitis
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Date
2023-05
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Abstract
AIM: This study investigated febrile children with petechial rashes who presented to European emergency departments (EDs) and investigated the role that mechanical causes played in diagnoses. METHODS: Consecutive patients with fever presenting to EDs in 11 European emergency departments in 2017-2018 were enrolled. The cause and focus of infection were identified and a detailed analysis was performed on children with petechial rashes. The results are presented as odds ratios (OR) with 95% confidence intervals (CI). RESULTS: We found that 453/34,010 (1.3%) febrile children had petechial rashes. The focus of the infection included sepsis (10/453, 2.2%) and meningitis (14/453, 3.1%). Children with a petechial rash were more likely than other febrile children to have sepsis or meningitis (OR 8.5, 95% CI 5.3-13.1) and bacterial infections (OR 1.4, 95% CI 1.0-1.8) as well as need for immediate life-saving interventions (OR 6.6, 95% CI 4.4-9.5) and intensive care unit admissions (OR 6.5, 95% CI 3.0-12.5). CONCLUSION: The combination of fever and petechial rash is still an important warning sign for childhood sepsis and meningitis. Ruling out coughing and/or vomiting was insufficient to safely identify low-risk patients.
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Funding Information: This project received funding from the European Union's Horizon 2020 research and innovation programme under grant agreement no. 668303. The research was supported by the National Institute for Health Research Biomedical Research Centres at Imperial College London, Newcastle Hospitals NHS Foundation Trust and Newcastle University. Publisher Copyright: © 2023 The Authors. Acta Paediatrica published by John Wiley & Sons Ltd on behalf of Foundation Acta Paediatrica.
Keywords
Petechial rash, febrile illness, mechanical cause of petechiae, meningitis, sepsis, 3.2 Clinical medicine, 1.1. Scientific article indexed in Web of Science and/or Scopus database
Citation
Kohlmaier, B, Leitner, M, Hagedoorn, N N, Zavadska, D & PERFORM consortium (Personalised Risk assessment in febrile children to optimise Real-life Management across the European Union) 2023, 'European study confirms the combination of fever and petechial rash as an important warning sign for childhood sepsis and meningitis', Acta Paediatrica, vol. 112, no. 5, pp. 1058-1066. https://doi.org/10.1111/apa.16740