All children with a non-blanching rash and fever will require a period of observation in hospital. They may be discharged if they remain well and investigations are normal, but some will require admission to the ward overnight.
Children with a non-blanching rash depending on the distribution and spread will require blood tests to check for possible causes (Usually FBC, clotting profile, infection screen if pyrexial). They will be observed in the Paediatric Assessment Unit (PAU) to ensure the rash is not rapidly spreading.
A diagnostic work up will help to identify the cause leading to non-blanching rash and a serious medical case can be identified and treated. If the child is well, and there is a clear history of a mechanical cause, then it may be decided that observation only is sufficient. This may include petechiae in the SVC distribution (above the nipple line) where there is a history of forceful coughing or vomiting.
Children unwell with fevers and non-blanching rash will be initiated on IV antibiotics (usually ceftriaxone). They may be admitted if unwell, or may be ambulated with ongoing doses either on PAU or in the community by our community nursing team.