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Recent publicity surrounding meningococcal infection in children has led to an increased awareness by both doctors and parents of the symptoms and signs. The appearance of a petechial or purpuric skin rash which does not blanch when pressed with a glass is a sign which has been particularly publicised and is widely known. While this is an important and recognisable feature, many children with such a rash do not have meningococcal infection. However, many are admitted to hospital and treated with antibiotics. General paediatricians, accident and emergency departments, and general practitioners who see the children first need guidance on recognising those who are likely to have meningococcal infection.
The aim of this study was to determine whether it is possible to predict which children with a non-blanching rash do or do not have meningococcal infection, based on the characteristics of the rash, other physical signs, and simple laboratory investigations at the time of presentation.
Methods
SUBJECTS
We prospectively enrolled all infants and children aged 15 years or less with a non-blanching rash who presented to our children's accident and emergency department over a 12 month period from 1 November 1998 to 31 October 1999 (either self or general practitioner referral). The department is the only one in the city of Nottingham and serves the children from a population of about 800 000 (a paediatric population of 135 000). All patients with a non-blanching rash were included. We defined petechiae as non-blanching spots in the skin, less than 2 mm in diameter, and known to be new in onset. The lesions were classed as purpura if they were more than 2 mm in diameter.
METHOD
The study was entirely observational-care was determined by the on-call paediatric medical team. A member of the paediatric medical team collected the data in the children's accident and emergency department, entering it on a standard proforma at the time of presentation of the child. The following data were recorded: presenting symptoms and signs, including axillary temperature, blood pressure (hypotension was defined as 2 SD or more below the mean for age), capillary refill time (defined as normal if less than 2 seconds), 1 and details of the rash (size and distribution). Children were also characterised as being either well (smiling or...