TY - JOUR T1 - Diagnostic assessment of haemorrhagic rash and fever JF - Archives of Disease in Childhood JO - Arch Dis Child SP - 160 LP - 165 DO - 10.1136/adc.85.2.160 VL - 85 IS - 2 AU - H E Nielsen AU - E A Andersen AU - J Andersen AU - B Böttiger AU - K M Christiansen AU - P Daugbjerg AU - S O Larsen AU - I Lind AU - M Nir AU - K Olofsson Y1 - 2001/08/01 UR - http://adc.bmj.com/content/85/2/160.abstract N2 - AIMS To establish criteria for early distinction between meningococcal disease and other conditions with similar clinical features, and to identify other causes for haemorrhagic rashes accompanied by fever.METHODS In a prospective study, 264 infants and children hospitalised with fever and skin haemorrhages were studied.RESULTS We identified an aetiological agent in 28%: 15% had meningococcal disease, 2% another invasive bacterial infection, 7% enterovirus infection, and 4% adenovirus infection. Five clinical variables distinguished between meningococcal disease and other conditions on admission: (1) skin haemorrhages of characteristic appearance; (2) universal distribution of skin haemorrhages; (3) maximum diameter of one or more skin haemorrhages greater than 2 mm; (4) poor general condition (using a standardised observation scheme); and (5) nuchal rigidity. If any two or more of these clinical variables were present, the probability of identifying a patient with meningococcal disease was 97% and the false positive rate was only 12%. This diagnostic algorithm did not identify children in whom septicaemia was caused by other bacterial species. ER -