Petechiae in Children (PiC) Study
: evaluating potential clinical decision rules for the management of feverish children with non-blanching rashes, including the role of point of care testing for Procalcitonin & Neisseria meningitidis DNA

Student thesis: Doctoral ThesisDoctor of Philosophy


The aim of this prospective cohort study was to report the performance of existing clinical practice guidelines (CPG) for diagnosis of invasive meningococcal disease (MD) in children presenting with fever and non-blanching rash in the UK.

Data were collected prospectively from 37 UK Emergency Departments (ED) between November2017 and June 2019. Children under 18 years of age presenting with fever and non-blanching rash were included. Invasive meningococcal disease was confirmed by positive culture/quantitative PCR for N. meningitidis from either blood or cerebrospinal fluid.

A total of 1329patients were included in the analysis. Median age was 24 months (interquartile range 12 to 48), 1137(85·6%) underwent blood testing, and 596(44·8%) received parenteral antibiotics. There were 19 cases of MD (1·4%). All CPGs (n=8)demonstrated a sensitivity of 1·00 for the identification of MD. National Institute for Health and Care Excellence (NICE) guidelines CG102 and NG51demonstrated specificities of 0·00 and 0·01 respectively for the identification of MD. The specificities of the NICE CPGs were significantly lower(p<0.0001) than all other CPGs. The best performing CPGs were the London and Nottingham CPGs with specificities of 0.36 and 0.34 respectively for the identification of MD.

In the UK invasive meningococcal disease is now a rare cause of non-blanching rashes in children presenting to the ED. Current NICE guidance performs poorly when compared to alternative CPGs.

Date of AwardJul 2020
Original languageEnglish
Awarding Institution
  • Queen's University Belfast
SponsorsNorthern Ireland Public Health Agency
SupervisorMichael Shields (Supervisor), Derek Fairley (Supervisor) & Fiona Lynn (Supervisor)

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