{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,27]],"date-time":"2026-02-27T03:36:35Z","timestamp":1772163395075,"version":"3.50.1"},"reference-count":28,"publisher":"BMJ","issue":"8","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Arch Dis Child"],"published-print":{"date-parts":[[2016,8]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Paediatricians are concerned that children who present with a non-blanching rash (NBR) may have meningococcal disease (MCD). Two algorithms have been devised to help identify which children with an NBR have MCD.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>To evaluate the NBR algorithms\u2019 ability to identify children with MCD.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>The Newcastle-Birmingham-Liverpool (NBL) algorithm was applied retrospectively to three cohorts of children who had presented with NBRs. This algorithm was also piloted in four hospitals, and then used prospectively for 12\u2005months in one hospital. The National Institute for Health and Care Excellence (NICE) algorithm was validated retrospectively using data from all cohorts.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The cohorts included 625 children, 145 (23%) of whom had confirmed or probable MCD. Paediatricians empirically treated 324 (52%) children with antibiotics. The NBL algorithm identified all children with MCD and suggested treatment for a further 86 children (sensitivity 100%, specificity 82%). One child with MCD did not receive immediate antibiotic treatment, despite this being suggested by the algorithm. The NICE algorithm suggested 382 children (61%) who should be treated with antibiotics. This included 141 of the 145 children with MCD (sensitivity 97%, specificity 50%).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>These algorithms may help paediatricians identify children with MCD who present with NBRs. The NBL algorithm may be more specific than the NICE algorithm as it includes fewer features suggesting MCD. The only significant delay in treatment of MCD occurred when the algorithms were not followed.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/archdischild-2015-309451","type":"journal-article","created":{"date-parts":[[2016,3,16]],"date-time":"2016-03-16T23:18:43Z","timestamp":1458170323000},"page":"709-713","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":10,"title":["Validation of two algorithms for managing children with a non-blanching rash"],"prefix":"10.1136","volume":"101","author":[{"given":"F Andrew I","family":"Riordan","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Laura","family":"Jones","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Julia","family":"Clark","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2016,3,16]]},"reference":[{"key":"key-10.1136\/archdischild-2015-309451-1","doi-asserted-by":"crossref","first-page":"685","DOI":"10.1136\/bmj.38968.683958.AE","article-title":"Meningococcal disease and its management in children","volume":"333","author":"Hart","year":"2006","journal-title":"BMJ"},{"key":"key-10.1136\/archdischild-2015-309451-2","doi-asserted-by":"crossref","first-page":"386","DOI":"10.1136\/adc.85.5.386","article-title":"Reduction in case fatality rate from meningococcal disease associated with improved healthcare delivery","volume":"85","author":"Booy","year":"2001","journal-title":"Arch Dis Child"},{"key":"key-10.1136\/archdischild-2015-309451-3","doi-asserted-by":"crossref","first-page":"382","DOI":"10.1136\/adc.85.5.382","article-title":"Mortality in severe meningococcal disease","volume":"85","author":"Thorburn","year":"2001","journal-title":"Arch Dis Child"},{"key":"key-10.1136\/archdischild-2015-309451-4","doi-asserted-by":"crossref","first-page":"608","DOI":"10.1136\/adc.88.7.608","article-title":"Treatment of meningococcal infection","volume":"88","author":"Welch","year":"2003","journal-title":"Arch Dis Child"},{"key":"key-10.1136\/archdischild-2015-309451-5","doi-asserted-by":"crossref","first-page":"218","DOI":"10.1136\/adc.85.3.218","article-title":"The child with a non-blanching rash: how likely is meningococcal disease?","volume":"85","author":"Wells","year":"2001","journal-title":"Arch Dis Child"},{"key":"key-10.1136\/archdischild-2015-309451-6","doi-asserted-by":"crossref","first-page":"291","DOI":"10.1136\/adc.86.4.291","article-title":"Prevalence and distribution of petechiae in well babies","volume":"86","author":"Downes","year":"2002","journal-title":"Arch Dis Child"},{"key":"key-10.1136\/archdischild-2015-309451-7","doi-asserted-by":"crossref","first-page":"1135","DOI":"10.1097\/00006454-199812000-00007","article-title":"Evaluation of febrile children with petechial rashes: is there consensus among pediatricians?","volume":"17","author":"Nelson","year":"1998","journal-title":"Pediatr Infect Dis J"},{"key":"key-10.1136\/archdischild-2015-309451-8","doi-asserted-by":"crossref","first-page":"506","DOI":"10.1136\/adc.83.6.506","article-title":"The management of fever and petechiae: making sense of rash decisions","volume":"83","author":"Brogan","year":"2000","journal-title":"Arch Dis Child"},{"issue":"1","key":"key-10.1136\/archdischild-2015-309451-9","doi-asserted-by":"crossref","first-page":"i51","DOI":"10.1093\/jac\/dks202","article-title":"Improving the quality of antibiotic prescribing in the NHS by developing a new Antimicrobial Stewardship Programme: Start Smart\u2014then focus","volume":"67","author":"Ashiru-Oredope","year":"2012","journal-title":"J Antimicrob Chemother"},{"key":"key-10.1136\/archdischild-2015-309451-10","doi-asserted-by":"crossref","first-page":"172","DOI":"10.1136\/adc.85.2.172a","article-title":"The management of fever and petechiae: collaborative studies are needed","volume":"85","author":"Richards","year":"2001","journal-title":"Arch Dis Child"},{"key":"key-10.1136\/archdischild-2015-309451-11","unstructured":"NICE Clinical Guideline 102. 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