Children with Fever and Petechial Rash Presenting to the Paediatric Emergency Department (ED): A European Multicentre Observational Study


Kohlmaier, Benno, Leitner, Manuel, Hagedoorn, Nienke N, Borensztajn, Dorine, von Both, Ulrich, Carrol, Enitan ORCID: 0000-0001-8357-7726, Emonts, Marieke, van der Flier, Michiel, De Groot, Ronald, Herberg, Jethro A et al (show 14 more authors) (2022) Children with Fever and Petechial Rash Presenting to the Paediatric Emergency Department (ED): A European Multicentre Observational Study [Preprint]

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Abstract

Introduction: Fever and petechial rash in children is a well-known warning sign for serious disease such as meningitis and sepsis. Since the introduction of effective vaccinations, many febrile patients with petechial rash suffer from self-limiting illness, but some still have sepsis or meningitis. Given the high mortality without timely treatment, it remains important to identify those at risk. In order to recognize a low-risk group, it was hypothesized that clinical appearance and potential mechanical cause of petechiae (coughing or vomiting) might help to differentiate, but the reliability of this hypothesis has not been examined outside the UK. In this study we investigated findings from children with fever and petechial rash presenting to European emergency departments (ED) to identify possible predictive clinical characteristics.Methods: Consecutive patients with fever presenting to the paediatric emergency department were prospectively included in twelve different EDs in eight different European countries from January 2017 to April 2018. Patients with petechial rash were compared to patients without a rash or other types of rashes. Further, patients with petechial rash were stratified according to focus of infection (sepsis/meningitis vs. others) and cause of infection (bacterial vs. non-bacterial).Results: A total of 34,010 febrile patients with recorded rash status, of whom 453 (1.3%) had a petechial rash. 67 patients (15%) had a bacterial infection as cause of infection. Ten patients (2.2%) had sepsis and 14 patients (3.1%) had meningitis as focus of infection. In patients with petechial rash, sepsis or meningitis were more frequent compared to other febrile patients (OR=8.5 [5.3-13.1], p<0.001), as well as bacterial infection (OR=1.4 [1.0-1.8], p=0.023), use of immediate life-saving interventions (OR=6.6 [4.4-9.5], p<0.001) and ICU admissions (OR=6.5 [3.0-12.5], p<0.001). Patients with sepsis or meningitis often presented with vomiting (62%) and coughing (39%), whereas 3 (14%) patients were described as well appearing.Conclusion: We conclude that the combination of fever and petechial rash in children is still an important warning sign for sepsis and meningitis. The presence of coughing and/or vomiting as well as clinical appearance were no suitable markers to safely identify a low-risk group.Funding Information: This project has 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.Declaration of Interests: None.Ethics Approval Statement: The study was approved by the ethical committees of all the participating hospitals and no informed consent was needed for this study. Austria: Ethikkommission Medizinische Universitat Graz (ID: 28- 518ex15/16); Germany: Ethikkommission LMU München (ID: 699- 16); Greece: Ethics Committee (ID: 9683/18.07.2016); Latvia: Centrala medicinas etikas komiteja (ID: 14.07.201.6.No. Il16- 07- 14); Slovenia: Republic of Slovenia National Medical Ethics Committee (ID: 0120- 483/2016- 3); Spain: Comité Autonómico de Ética de la Investigación de Galicia (ID: 2016/331); the Netherlands: Commissie Mensgebonden Onderzoek (ID: NL58103.091.16); UK: Ethics Committee (ID: 16/LO/1684, IRAS application number 209035; confidentiality advisory group reference: 16/CAG/0136). In all the participating UK settings, an additional opt-out mechanism was in place.

Item Type: Preprint
Uncontrolled Keywords: 32 Biomedical and Clinical Sciences, 3202 Clinical Sciences, Emergency Care, Sepsis, Hematology, Infectious Diseases, Clinical Research, Infection, 3 Good Health and Well Being
Divisions: Faculty of Health & Life Sciences
Faculty of Health & Life Sciences > Inst. Infection, Vet & Ecological Sciences
Depositing User: Symplectic Admin
Date Deposited: 10 Jun 2024 09:21
Last Modified: 06 Mar 2026 19:54
DOI: 10.2139/ssrn.4169809
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URI: https://livrepository.liverpool.ac.uk/id/eprint/3182103
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