title: Prolonged partial thromboplastin times in children with fever and petechiae without bacteremia or sepsis.
abstract: OBJECTIVE
  In a prior uncontrolled study, 23% of children with fever and petechiae without bacteremia or sepsis had a prolonged partial thromboplastin time (PTT). We attempted to validate this finding by comparing the PTTs of children with fever and petechiae who were neither septic nor bacteremic with those of children without fever and petechiae.
  
  
  METHODS
  Design. Secondary analysis of a prospective cohort with a newly identified retrospective control cohort. Setting. Emergency department of an urban pediatric teaching hospital from December 1993 to June 1995. Study group. All patients 1 month to 18 years old from a previously identified cohort with (1) fever (temperature >or=38.0); (2) petechiae; (3) prothrombin time and partial thromboplastin time performed in the emergency department (n = 273). Control group. Age-matched patients 1 month to 18 years old who presented to the emergency department during the same time period as the study patients with (1) an injury or other potentially surgical diagnosis; (2) neither fever nor petechiae; (3) prothrombin time and partial thromboplastin time performed in the emergency department. Main outcome measures. partial thromboplastin time and prothrombin time.
  
  
  RESULTS
  117 control patients were identified. Partial thromboplastin time was prolonged in 23% of study patients, but in only 6% of control patients (P < 0.001). Prothrombin time was prolonged in 9% of patients with fever and petechiae compared with only 4% of control patients (P = 0.09).
  
  
  CONCLUSIONS
  Children with fever and petechiae without bacteremia or sepsis are more likely than controls to have prolonged partial thromboplastin time.
authors.affiliation: Division of Pediatric Emergency Medicine, Children's Hospital Boston, Boston, MA 02115, USA. ben.willwerth@tch.harvard.edu
authors.forename: Ben M
authors.initials: BM
authors.lastname: Willwerth
authors.forename: Marvin B
authors.initials: MB
authors.lastname: Harper
authors.forename: Kenneth D
authors.initials: KD
authors.lastname: Mandl
mesh_terms: D000293:Adolescent; D016470:Bacteremia / Q000175:diagnosis; D001424:Bacterial Infections / Q000097:blood / Q000150:complications / Q000175:diagnosis; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003937:Diagnosis, Differential; D004630:Emergencies; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D005334:Fever / Q000097:blood* / Q000209:etiology; D005340:Fibrinogen / Q000032:analysis; D006776:Hospitals, Pediatric / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D010314:Partial Thromboplastin Time; D011517:Prothrombin Time; D011693:Purpura / Q000097:blood* / Q000209:etiology; D012189:Retrospective Studies; D018805:Sepsis / Q000175:diagnosis; D013921:Thrombocytopenia / Q000097:blood / Q000150:complications; D014777:Virus Diseases / Q000097:blood / Q000150:complications / Q000175:diagnosis
chemical_list: D005340:Fibrinogen