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Evaluation of febrile children with petechial rashes: is there consensus among pediatricians?

D G Nelson1, J Leake, J Bradley

  • 1Department of Pediatrics, Hasbro Children's Hospital, Brown University School of Medicine, Providence, RI, USA.

The Pediatric Infectious Disease Journal
|January 7, 1999
PubMed

Insights

Pediatricians show varied approaches to evaluating febrile children with petechial rashes. While differences exist among specialists, most practice variations in managing these cases diminish with experience and setting adjustments.

Area of Science:

  • Pediatric infectious diseases
  • Clinical practice variations
  • Febrile illness management

Background:

  • Febrile children with petechial rashes present a diagnostic challenge due to potential for serious infections like Neisseria meningitidis.
  • Current evaluation and management strategies for these children are subject to debate.

Purpose of the Study:

  • To identify and compare practice trends in evaluating and managing non-toxic-appearing febrile children with petechial rashes across different pediatric subspecialties.
  • To understand how factors like clinical presentation and laboratory results influence physician decision-making.

Main Methods:

  • A survey was distributed to 416 pediatricians across general pediatrics (community and academic), emergency medicine, and infectious diseases.
  • Respondents evaluated four hypothetical cases of febrile children with petechial rashes, varying in age, appearance, and lab results.
  • Logistic regression analysis was used to compare specialty group responses, controlling for practice setting, population size, and physician experience.

Main Results:

  • Significant variations were observed in blood culture rates and hospital admissions for younger children, particularly between emergency medicine and general pediatrics groups.
  • For older children with clear sources for petechiae, most physicians opted against lumbar puncture or admission, though blood culture use varied.
  • Regression analysis indicated that practice setting, population size, and physician experience accounted for most observed differences between groups.

Conclusions:

  • Substantial differences exist in how pediatricians evaluate young febrile children with petechial rashes.
  • While some inter-specialty variations in practice are noted, these tend to decrease when accounting for practice environment and physician experience.
Abstract

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