Ep 23 – Non-blanching rash in children

In her first podcast for GPnotebook, Dr Kate Chesterman discusses new evidence on the management of children with non-blanching rashes with Dr Edward Snelson. Dr Snelson is a Consultant Emergency Paediatrician at Sheffield Children’s Hospital and is the author of the blog GPpaedstips. Should we be treating every non-blanching rash as meningococcal disease, and if not, why not? What important differentials do we want to consider in children with a fever and a non-blanching rash? Can GPs safely decide which children require emergency treatment?

Key references and resources discussed in the episode:

• GPpaedstips. Everything has changed - Non-blanching rash in children.
• Waterfield T et al. Lancet Infect Dis. 2021;21(4):569-577. doi: 10.1016/S1473-3099(20)30474-6.

Flowchart (courtesy of gppaedstips.blogspot.com)


Key take-home points from the episode:

1. Invasive meningococcal disease is a rare but serious cause of non-blanching rashes in children.
2. The presence of petechiae alone should no longer be viewed as a red flag.
3. Careful clinical assessment for other signs of sepsis and meningococcal disease by an experienced clinician can reduce over investigation, treatment and admissions.