Vanishing evidence of the non-blanching rash?

Abstract

In The Lancet Infectious Diseases, Thomas Waterfield and colleagues 1 Waterfield T Maney J-A Fairley D et al. Validating clinical practice guidelines for the management of children with non-blanching rashes in the UK (PiC): a prospective, multicentre cohort study. Lancet Infect Dis. 2020; (published online Nov 10.)https://doi.org/10.1016/S1473-3099(20)30474-6 Summary Full Text Full Text PDF Scopus (6) Google Scholar present the results of the Petechiae in Children (PiC) study, which was a large study of invasive meningococcal disease in febrile children with non-blanching rashes who presented to a range of hospital emergency departments in the UK between November, 2017, and June, 2019. The study describes the limitations and strengths of eight current clinical practice guidelines in the current era of low invasive meningococcal disease prevalence. The Article nicely shows some important points. First, the proportion of participants who had invasive meningococcal disease was low (19 [1%] of 1329 patients). However, Neisseria meningitidis infection is still one of the leading causes of morbidity and mortality among febrile children. Second, all eight clinical practice guidelines included in the study 1 Waterfield T Maney J-A Fairley D et al. Validating clinical practice guidelines for the management of children with non-blanching rashes in the UK (PiC): a prospective, multicentre cohort study. Lancet Infect Dis. 2020; (published online Nov 10.)https://doi.org/10.1016/S1473-3099(20)30474-6 Summary Full Text Full Text PDF Scopus (6) Google Scholar had high sensitivities but very different specificities. Finally, individual clinician decision making was associated with the lowest number of interventions, but at the cost of a higher number of missed invasive meningococcal disease cases when compared with the clinical practice guidelines. Validating clinical practice guidelines for the management of children with non-blanching rashes in the UK (PiC): a prospective, multicentre cohort studyInvasive meningococcal disease is a rare cause of non-blanching rashes in children presenting to the emergency department in the UK. Current NICE guidelines perform poorly when compared with tailored clinical practice guidelines. These findings suggest that UK national guidance could be improved by shifting towards a tailored approach. Full-Text PDF