Validation of two algorithms for managing children with a non-blanching rash. Issue 8 (16th March 2016)

• Record Type: Journal Article
• Authors: Riordan, F Andrew I; Jones, Laura; Clark, Julia
• Other Names: author non-byline.; Bridges Sarah author non-byline.; Dykes Linda author non-byline.; Morjaria Anu author non-byline.; Newton Tina author non-byline.; Richards Chris author non-byline.; Shackley Fiona author non-byline.; Thimm Ansgar author non-byline.
• Is Part Of: Archives of disease in childhood. Volume 101:Issue 8(2016)
• Page Start: 709
• Page End: 713
• Publication Date: 2016-03-16
• Subjects: Infectious Diseases -- General Paediatrics; Children -- Diseases -- Periodicals; Infants -- Diseases -- Periodicals; 618.920005
• DOI: 10.1136/archdischild-2015-309451
• Languages: English
• ISSNs: 0003-9888

Abstract

Abstract : Background: Paediatricians are concerned that children who present with a non-blanching rash (NBR) may have meningococcal disease (MCD). Two algorithms have been devised to help identify which children with an NBR have MCD. Aim: To evaluate the NBR algorithms' ability to identify children with MCD. Methods: The Newcastle-Birmingham-Liverpool (NBL) algorithm was applied retrospectively to three cohorts of children who had presented with NBRs. This algorithm was also piloted in four hospitals, and then used prospectively for 12 months in one hospital. The National Institute for Health and Care Excellence (NICE) algorithm was validated retrospectively using data from all cohorts. Results: The cohorts included 625 children, 145 (23%) of whom had confirmed or probable MCD. Paediatricians empirically treated 324 (52%) children with antibiotics. The NBL algorithm identified all children with MCD and suggested treatment for a further 86 children (sensitivity 100%, specificity 82%). One child with MCD did not receive immediate antibiotic treatment, despite this being suggested by the algorithm. The NICE algorithm suggested 382 children (61%) who should be treated with antibiotics. This included 141 of the 145 children with MCD (sensitivity 97%, specificity 50%). Conclusions: These algorithms may help paediatricians identify children with MCD who present with NBRs. The NBL algorithm may be more specific than the NICE algorithm as it includes fewer features suggesting MCD. The only significant delay in treatment of MCD occurred when the algorithms were not followed.