title: Diagnostic assessment of haemorrhagic rash and fever.
abstract: OBJECTIVE
  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.
authors.affiliation: This paper is also published in the journal Ugeskrift for Laeger Paediatric Department, Gentofte Hospital, N. Andersensvej, 2900 Hellerup, Denmark. Hanie@gentoftehosp.kbhamt.dk
authors.forename: H E
authors.initials: HE
authors.lastname: Nielsen
authors.forename: E A
authors.initials: EA
authors.lastname: Andersen
authors.forename: J
authors.initials: J
authors.lastname: Andersen
authors.forename: B
authors.initials: B
authors.lastname: Böttiger
authors.forename: K M
authors.initials: KM
authors.lastname: Christiansen
authors.forename: P
authors.initials: P
authors.lastname: Daugbjerg
authors.forename: S O
authors.initials: SO
authors.lastname: Larsen
authors.forename: I
authors.initials: I
authors.lastname: Lind
authors.forename: M
authors.initials: M
authors.lastname: Nir
authors.forename: K
authors.initials: K
authors.lastname: Olofsson
mesh_terms: D000258:Adenovirus Infections, Human / Q000150:complications / Q000175:diagnosis; D000465:Algorithms; D002648:Child; D002675:Child, Preschool; D003937:Diagnosis, Differential; D004769:Enterovirus Infections / Q000150:complications / Q000175:diagnosis; D005334:Fever / Q000209:etiology*; D006801:Humans; D007223:Infant; D016015:Logistic Models; D008589:Meningococcal Infections / Q000150:complications* / Q000175:diagnosis; D009127:Muscle Rigidity / Q000175:diagnosis / Q000209:etiology; D011446:Prospective Studies; D011693:Purpura / Q000209:etiology*; D018709:Statistics, Nonparametric