MEDICAL PRACTICE IN CHILDREN PRESENTING FEVER WITH PETECHIAL RASH TO AN EMERGENCY DEPARTMENT

Authors

  • Ioana DUMITRASCU-BIRIS Emergency Hospital for Children ”Louis Turcanu”-Timisoara
  • Adela CHIRITA-EMANDI Emergency Hospital for Children ”Louis Turcanu”-Timisoara
  • Imelda LAMBERT Midland Regional Hospital, Mullingar, Ireland
  • Otilia MARGINEAN University of Medicine and Pharmacy”Victor Babes”-Timisoara
  • Farhana SHARIF Royal College of Surgeons in Ireland

Abstract

Introduction: The association of fever and petechiae in children is one of the most alarming findings for a paediatrician. To quickly distinguish between benign and life-threatening conditions is challenging in many cases. We aimed to evaluate the clinical practice of children presenting with fever and petechiae as initial symptoms. Methods: 41 patients (age 3 months-11 years) presenting with fever and petechiae were identified in an Emergency Paediatric Assessment Unit over a period of 9 months. General data, symptoms and signs were assessed for each patient. The work-up consisted in: complete blood count, inflammatory tests, coagulation tests, Monospot test, nasopharyngeal rapid tests, blood culture, and cerebrospinal fluid culture where appropriate. Results: Most children were <5 years of age (70.7%). Female to male ratio was 1:2.4. The most common clinical diagnoses were: viral respiratory illness (48.8%, 20/41) and upper respiratory tract infection (17.1%, 7/41). Meningococcal disease was found in one case. CRP>6 mg/l was poorly correlated with serious illness. The following variables were strongly associated with serious illness: ill appearance, shivering, lethargy, back rigidity, ESR>50 mm/h and prolonged capillary refill time. 59%(24/41) of children were treated with antibiotics, however, at discharge 42%(10/24) of them, did not have a work-up suggestive for a bacterial illness. Conclusions: Screening for low prevalence but high morbidity conditions, as the meningococcal disease, with an extensive work-up is time and resource consuming and may lead to unmotivated antibiotic use. Larger studies are needed to change the emergency practice for management of fever and rash.

Author Biographies

  • Ioana DUMITRASCU-BIRIS, Emergency Hospital for Children ”Louis Turcanu”-Timisoara

    Paediatrics Department
    Midland Regional Hospital, Mullingar, Ireland
    Paediatrics Department

  • Adela CHIRITA-EMANDI, Emergency Hospital for Children ”Louis Turcanu”-Timisoara

    Paediatrics Department

  • Imelda LAMBERT, Midland Regional Hospital, Mullingar, Ireland

    Paediatrics Department

  • Otilia MARGINEAN, University of Medicine and Pharmacy”Victor Babes”-Timisoara

    Genetics Department
    Emergency Hospital for Children ”Louis Turcanu”-Timisoara
    Paediatrics Department

  • Farhana SHARIF, Royal College of Surgeons in Ireland

    Paediatrics Department
    Midland Regional Hospital, Mullingar, Ireland
    Paediatrics Department

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Additional Files

Published

2016-06-30

Issue

Vol. 120 No. 2 (2016): The Medical-Surgical Journal

Section

INTERNAL MEDICINE - PEDIATRICS

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