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Validation of two algorithms for managing children with a non-blanching rash
  1. F Andrew I Riordan1,
  2. Laura Jones2,
  3. Julia Clark3
  4. on behalf of the Non-Blanching Rash Audit Group
    1. 1Department of Child Health, Birmingham Heartlands Hospital, Birmingham, Alder Hey Children's Foundation NHS Trust, Liverpool, UK
    2. 2School of Clinical Medical Sciences (Child Health), University of Newcastle, Royal Hospital for Sick Children, Edinburgh, UK
    3. 3Great North Children's Hospital, Newcastle, Lady Cilento Children's Hospital, Brisbane, UK
    1. Correspondence to Dr A Riordan, Department of Paediatric Infectious Diseases, Alder Hey Children's Foundation NHS Trust, Eaton Road, Liverpool L12 2AP, UK; Andrew.riordan{at}


    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.

    • Infectious Diseases
    • General Paediatrics

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