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Clinical deterioration among patients with fever and erythroderma

Robyn L Byer1, Richard G Bachur

  • 1Division of Emergency Medicine, Children's Hospital, 300 Longwood Ave, Boston, MA 02115, USA. robyn.byer@childrens.harvard.edu

Pediatrics
|December 5, 2006
PubMed

Insights

Children with fever and erythroderma are at high risk for developing shock and toxic shock syndrome. Specific clinical features can help predict which children will experience hemodynamic deterioration, necessitating aggressive management.

Area of Science:

  • Pediatric Emergency Medicine
  • Infectious Diseases
  • Critical Care

Background:

  • Fever and erythroderma in children can rapidly progress to severe conditions like toxic shock syndrome.
  • Identifying predictive factors for hypotension and shock is crucial for timely intervention.

Purpose of the Study:

  • To identify clinical features predicting hypotension or toxic shock syndrome in children with fever and erythroderma.
  • To describe the clinical presentation, course, and outcomes of these pediatric patients.

Main Methods:

  • Retrospective medical chart review of pediatric patients (< or = 19 years) presenting with fever and erythroderma.
  • Data collection included historical, clinical, and laboratory parameters over a 60-month period.

Main Results:

  • 45% of patients developed shock; 33% of initially normotensive patients progressed to shock.
  • Key predictors for hypotension included older age, ill appearance, vomiting, specific lab values (glucose, calcium, creatinine, platelets), and focal infection.
  • Predictors for toxic shock syndrome were older age, ill appearance, elevated creatinine, and initial hypotension.

Conclusions:

  • Older age, vomiting, focal bacterial source, and laboratory parameters predict hemodynamic deterioration in children with fever and erythroderma.
  • Aggressive management and hospitalization are recommended for all children presenting with fever and erythroderma due to high risk of decompensation.
Abstract

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