title: MEDICAL PRACTICE IN CHILDREN PRESENTING FEVER WITH PETECHIAL RASH TO AN EMERGENCY DEPARTMENT.
abstract: BACKGROUND
  The association of fever and petechiae in children is one of the most alarming findings for a paediatrician. To quickly distinguish between benign and life-threatening conditions is challenging in many cases. We aimed to evaluate the clinical practice of children presenting with fever and petechiae as initial symptoms.
  
  
  METHODS
  41 patients (age 3 months-11 years) presenting with fever and petechiae were identified in an Emergency Paediatric Assessment Unit over a period of 9 months. General data, symptoms and signs were assessed for each patient. The work-up consisted in: complete blood count, inflammatory tests, coagulation tests, Monospot test, nasopharyngeal rapid tests, blood culture, and cerebrospinal fluid culture where appropriate.
  
  
  RESULTS
  Most children were <5 years of age (70.7%). Female to male ratio was 1:2.4. The most common clinical diagnoses were: viral respiratory illness (48.8%, 20/41) and upper respiratory tract infection (17.1%, 7/41). Meningococcal disease was found in one case. CRP>6 mg/l was poorly correlated with serious illness. The following variables were strongly associated with serious illness: ill appearance, shivering, lethargy, back rigidity, ESR>50 mm/h and prolonged capillary refill time. 59% (24/41) of children were treated with antibiotics, however, at discharge 42%(10/24) of them, did not have a work-up suggestive for a bacterial illness.
  
  
  CONCLUSIONS
  Screening for low prevalence but high morbidity conditions, as the meningococcal disease, with an extensive work-up is time and resource consuming and may lead to unmotivated antibiotic use. Larger studies are needed to change the emergency practice for management of fever and rash.
authors.forename: Ioana
authors.initials: I
authors.lastname: Dumitrascu-Biris
authors.forename: Adela
authors.initials: A
authors.lastname: Chirita-Emandi
authors.forename: Imelda
authors.initials: I
authors.lastname: Lambert
authors.forename: Otilia
authors.initials: O
authors.lastname: Marginean
authors.forename: Farhana
authors.initials: F
authors.lastname: Sharif
mesh_terms: D002648:Child; D002675:Child, Preschool; D003937:Diagnosis, Differential; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005076:Exanthema / Q000382:microbiology / Q000821:virology; D005260:Female; D005334:Fever / Q000382:microbiology / Q000821:virology; D006801:Humans; D007223:Infant; D008297:Male; D008589:Meningococcal Infections / Q000150:complications / Q000175:diagnosis; D009305:Nasopharynx / Q000382:microbiology / Q000821:virology; D015995:Prevalence; D011693:Purpura / Q000382:microbiology / Q000821:virology; D012141:Respiratory Tract Infections / Q000175:diagnosis* / Q000453:epidemiology / Q000382:microbiology* / Q000628:therapy / Q000821:virology; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012383:Romania / Q000453:epidemiology; D012720:Severity of Illness Index