Abstract 479 Poster Session III, Monday, 5/3 (poster 217)

Background A recent study examining the incidence of bacteremia in children with fever and petechiae found prothrombin time (PT) or partial thromboplastin time (PTT) to be prolonged in 27% of these patients. Objective To compare the coagulation times of children with fever and petechiae who were neither bacteremic nor septic to children without fever and petechiae. Methods Study design: secondary analysis of a retrospective cohort with a newly identified retrospective control cohort. Setting: the emergency department (ED) of an urban pediatric teaching hospital from 12/93-6/95. Study group: patients aged 1 month to 18 years from a previously identified cohort with fever (temperature ≥ 38.0) and petechiae who had PT and PTT performed in the ED (n=274). Patients who had evidence of sepsis or bacteremia (n=7, 2.6%) were excluded. Control group: patients aged 1 month to 18 years who 1) had coagulation studies performed in the ED; 2) presented to the ED during the same time period as the study patients; 3) were diagnosed with a fracture, head injury or intussusception; 4) did not have fever and petechiae. They were excluded if they had a history of malignancy, liver disease, AIDS, a chronic hematologic disorder, or a known serious bacterial infection. Measures: PT greater than 13.5 seconds and/or PTT greater than 30.0 seconds were considered abnormal. Results 283 control patients were identified; 22 (7.8%) had prolonged PT and/or PTT. Prolonged coagulation times were present in more than three times as many (69, 25.8%) of the 267 study group patients (OR 4.13, CI 2.4-7.3, p < 0.001). The difference in the proportion of patients with abnormal coagulation times by age subgroups: (Table) PT was prolonged in 8 (3.0%) study patients and 3 (1.1%) control patients, while PTT was prolonged in 68 (25.5%) study patients and 19 (6.7%) control patients. Mean platelet count was lower in children with fever and petechiae than in controls (270,000 +/- 112,000 vs 303,000 +/- 87,000/µL, p <0.001) and mean fibrinogen was higher in children with fever and petechiae than in controls (352 +/- 63 vs 252 +/- 125mg/dl, p <0.001). Conclusions Many children with fever and petechiae that are neither septic nor bacteremic have a prolonged PT or PTT, particularly PTT. Further studies, including testing patients with fever and petechiae for inhibitors such as lupus anticoagulant or deficiencies of factors in the PTT pathway, should be undertaken to discover the etiology of these findings.

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