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Paediatric Emergency Medicine
Invasive bacterial infection in children with fever and petechial rash in the emergency department: a national prospective observational study
  1. Pilar Storch-De-Gracia1,
  2. Jose Luis Fernández2,
  3. Roberto Velasco2,
  4. Itsaso Saez3,
  5. Rocío Rodrigo4,
  6. Sandra Yañez5,
  7. Ester Castellarnau6,
  8. Elena Gil7,
  9. Patricia del Rio8,
  10. Estíbaliz Garrido9,
  11. Antón Castaño10,
  12. Álvaro Perez11,
  13. María Cabrerizo12,
  14. María Hernández13,
  15. Juan Jesús Pérez14,
  16. María José de la Torre15,
  17. Gemma Nadal16,
  18. Javier Martínez17,
  19. Victoria Sánchez-Tatay18
  1. 1 Emergency Department, Hospital Infantil Universitario Nino Jesus, Madrid, Spain
  2. 2 Pediatric Emergency Department, Hospital Universitario Rio Hortega, Valladolid, Spain
  3. 3 Pediatric Emergency Department, Cruces University Hospital, Barakaldo, Spain
  4. 4 Pediatric Emergency Department, Vall d'Hebron University Hospital, Barcelona, Spain
  5. 5 Pediatric Emergency Department, Complejo Hospitalario Universitario A Coruña, Oleiros, Spain
  6. 6 Department of Pediatrics, Hospital Universitari de Tarragona Joan XXIII, Tarragona, Spain
  7. 7 Department of Pediatrics, Hospital Comarcal de Laredo, Laredo, Spain
  8. 8 Department of Pediatrics, Hospital of Mendaro, Mendaro, Spain
  9. 9 Pediatric Emergency Department, Hospital Universitario Central de Asturias, Oviedo, Spain
  10. 10 Pediatric Emergency Department, Hospital Universitario de Cabueñes, Gijon, Spain
  11. 11 Department of Pediatrics, Hospital Del Tajo, Aranjuez, Spain
  12. 12 Department of Pediatrics, Hospital Infanta Leonor, Madrid, Spain
  13. 13 Department of Pediatrics, Hospital Materno Infantil de Las Palmas, Las Palmas, Spain
  14. 14 Department of Pediatrics, Hospital Puerta del Mar, Cadiz, Spain
  15. 15 Department of Pediatrics, Hospital Universitario Reina Sofía, Cordoba, Spain
  16. 16 Department of Pediatrics, Hospital Universitari Arnau de Vilanova, Lleida, Spain
  17. 17 Department of Pediatrics, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Spain
  18. 18 Department of Pediatrics, Hospital Universitario Virgen del Rocío, Sevilla, Spain
  1. Correspondence to Dr Pilar Storch-De-Gracia, Emergency department, Hospital Infantil Universitario Nino Jesus, Madrid 28009, Spain; pilar.storchdegracia{at}salud.madrid.org

Abstract

Objective To determine the incidence and clinical predictors of invasive bacterial infection (IBI) in well-appearing children who present to the emergency department (ED) with fever and petechiae.

Design A prospective, observational, multicentre study was conducted in 18 hospitals between November 2017 and October 2019.

Patients A total of 688 patients were recruited.

Main outcome measures The primary outcome was the presence of IBI. Clinical features and laboratory test results were described and related to the presence of IBI.

Results Ten IBIs were found (1.5%), comprising eight cases of meningococcal disease and two of occult pneumococcal bacteraemia. Median age was 26.2 months (IQR 15.3–51.2). Blood samples were obtained from 575 patients (83.3%). Patients with an IBI had a shorter time from fever to ED visit (13.5 hours vs 24 hours) and between fever and rash onset (3.5 hours vs 24 hours). Values for absolute leucocyte count, total neutrophil count, C reactive protein and procalcitonin were significantly higher in patients with an IBI. Significantly fewer patients with a favourable clinical status while in the observation unit were found to have an IBI (2/408 patients, 0.5%) than when clinical status was unfavourable (3/18, 16.7%).

Conclusions The incidence of IBI among children with fever and petechial rash is lower than previously reported (1.5%). The time from fever to ED visit and to rash onset was shorter in patients with an IBI. Patients with a favourable clinical course during observation in the ED are at lower risk of IBI.

  • emergency service, hospital
  • infectious disease medicine
  • paediatric emergency medicine
  • sepsis

Data availability statement

Data are available upon reasonable request.

https://doi.org/10.1136/archdischild-2022-325281

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    Data availability statement

    Data are available upon reasonable request.

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    Footnotes

    • Twitter @RoberVelasco80, @x4yi

    • Contributors PS-D-G contributed to the study conception and design, material preparation and analysis, wrote the first draft of the manuscript and act as the guarantor. JLF conceptualised and designed the study, coordinated and supervised the data collection, and critically reviewed the manuscript. RV contributed to the study conception and design, carried out the initial analyses and critically reviewed the manuscript. The following doctors revised the data collection form, collected data and critically reviewed the manuscript: IS, RR, SY, EC, EG, PdR, EG, AC, AJPD, MC, MH, JJP, MJdlT, GN, JM and VS-T. All authors approved the final manuscript as submitted and agreed to be accountable for all aspects contained.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

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