Validating clinical practice guidelines for the management of children with non-blanching rashes in the UK (PiC): a prospective, multicentre cohort study
| Autor: | Thomas Waterfield, Juli-Ann Maney, Derek Fairley, Mark D Lyttle, James P McKenna, Damian Roland, Michael Corr, Lisa McFetridge, Hannah Mitchell, Kerry Woolfall, Fiona Lynn, Bethany Patenall, Michael D Shields, Amy Kitching, Matthew Rotheram, Gisela Robinson, Paula Brassey, Stuart Hartshorn, Rachel Wane, Mark Lyttle, Jo Dangerfield, Michael Hayes, Rebecca McFarlane, Helen Armstrong, Sally Smith, Carl VanHeyningen, Esther Wilson, Lisa Kehler, Christopher Gough, Fraser Scott, Claire Backhouse, Sylvester Gomes, Darryl Wood, Julie-Ann Maney, Graham Johnson, Steven Foster, Ben Bloom, Andrew Lancaster, Sebastian Gray, Shammi Ramlakhan, Sharryn Gardner, Sharon Floyd, Chris Cleaver, Susan MacFarlane, Claire Bell, Maggie Nyirenda, Jane Bayreuther, Asim Ijaz, Natalie Rogers, Sarah Wilson, Sarah Diment, Caroline Boulind, Kathryn Allison, James McKenna, Bethany Petenall, Michael Shields |
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| Rok vydání: | 2021 |
| Předmět: |
DNA
Bacterial Male Pediatrics medicine.medical_specialty Meningococcal Infections/complications Fever Meningococcal Vaccines Fever/diagnosis Neisseria meningitidis DNA Bacterial/isolation & purification Real-Time Polymerase Chain Reaction Meningococcal disease Diagnosis Differential SDG 3 - Good Health and Well-being Humans Medicine Blood test Prospective Studies Prospective cohort study medicine.diagnostic_test business.industry Infant Neisseria meningitidis/genetics Emergency department Guideline Exanthema medicine.disease Thrombocytopenic purpura Rash United Kingdom Meningococcal Infections Exanthema/diagnosis Meningococcal Vaccines/administration & dosage Infectious Diseases Child Preschool Practice Guidelines as Topic Female medicine.symptom business Cohort study |
| Zdroj: | The Lancet. Infectious diseases Paediatric Emergency Research in the UK and Ireland (PERUKI) Group 2021, ' Validating clinical practice guidelines for the management of children with non-blanching rashes in the UK (PiC) a prospective, multicentre cohort study ', The Lancet Infectious Diseases, vol. 21, no. 4, pp. 569-577 . https://doi.org/10.1016/S1473-3099(20)30474-6 |
| ISSN: | 1473-3099 |
| DOI: | 10.1016/s1473-3099(20)30474-6 |
| Popis: | BACKGROUND: No previous studies have validated current clinical practice guidelines for the management of non-blanching rashes in children who have received meningococcal B and C vaccinations. The aim of this study was to evaluate the performance of existing clinical practice guidelines in the diagnosis of invasive meningococcal disease in children presenting with a fever and non-blanching rash in the UK.METHODS: The Petechiae in Children (PiC) study was a prospective, multicentre cohort study involving children (aged FINDINGS: Between Nov 9, 2017, and June 30, 2019, 1513 patients were screened, of whom 1329 were eligible and were included in the analysis. The median age of patients was 24 months (IQR 12-48). 1137 (86%) of 1329 patients had a blood test and 596 (45%) received parenteral antibiotics. 19 (1%) patients had confirmed meningococcal disease. All eight clinical practice guidelines had a sensitivity of 1·00 (95% CI 0·82-1·00) for identifying meningococcal disease. The specificities of NICE guidelines CG102 (0·01 [95% CI 0·01-0·02]) and NG51 (0·00 [0·00-0·00]) for identifying meningococcal disease were significantly lower than that of tailored clinical practice guidelines (pINTERPRETATION: Invasive 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.FUNDING: Public Health Agency. |
| Databáze: | OpenAIRE |
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