Dr Tom Waterfield wins the 2021 Donald Paterson prize

In memory of Dr Donald Paterson, we offer this award to one individual for the best published paper in paediatrics from the last two years. We hear from the Paterson family and we speak to Tom about his winning publication and its importance for child health.
Dr Tom Waterfield

After receiving many excellent applications, the winner of the Donald Paterson award is Dr Tom Waterfield for the publication Validating clinical practice guidelines for the management of children with non-blanching rashes in the United Kingdom. 

Tom, pictured, is a Clinical lecturer at Queen's University Belfast, and a recently qualified Consultant in Paediatric Emergency Medicine. He was the lead author for the Petechiae in Children (PiC) study.

Professor Nick Bishop, Vice President for Science and Research said:

This excellent paper, based on a prospective multicentre cohort study, clearly identifies the low level of risk for children of developing invasive meningococcal disease if they have received the meningococcus B and C vaccinations, and also found that use of clinical practice guidelines from a number of centres had equivalent sensitivity and higher specificity than the current NICE guidelines – so all affected children were correctly identified using both NICE and clinical practice guidelines, but use of the clinical practice guidelines reduced the numbers of unnecessary tests for non-infected children. These findings have relevance and impact across the UK and globally, and the application of the findings will hopefully improve care for affected children in the near future.

The family of Dr Donald Paterson said:

We are delighted to learn that the 2021 Donald Paterson Prize has been awarded to Tom Waterfield. We are honoured to be involved in presenting the Prize, and pleased that Donald Paterson's legacy continues in the pursuit of excellent health care for our children.

We spoke to Tom about this study, its importance and his personal drive for undertaking research. 

Can you tell us about your publication?

The aim of our research was to better understand what happens to children who attend hospital with a high temperature (fever) and a non-blanching rash. A non-blanching rash is a type of rash that doesn’t disappear with direct pressure or using the “tumbler test”.

Traditionally the combination of a non-blanching rash and fever was seen as a high risk presentation with as many as 1 in 5 children having a life-threatening infection known as meningococcal septicaemia or meningococcal meningitis. This led to almost all children with a fever and non-blanching rash undergoing painful procedures such as blood tests, spinal fluid testing as well as receiving high strength injected antibiotics.

Thankfully the meningococcal C vaccine (introduced in the UK in 1999) and the meningococcal B vaccine (introduced in the UK in 2015) have dramatically reduced the number of cases of meningococcal infection.

Our UK-wide research project, including over 1,300 children from 37 hospitals, demonstrated that meningococcal infection accounts for only 1% of presentations and that it is possible to safely identify a group of children that do not require painful procedures and do not require injected antibiotics.

What is the importance of this paper to child health?

These findings are important because they demonstrate the powerful effect of vaccinations, they minimise the harm caused by painful procedures and they help preserve our antibiotics by reducing the risk of resistance through overuse.

Why do you undertake research?

I am passionate about using evidence to improve the emergency care of children across the UK and Ireland. I conduct research so that I can better understand emergency presentations in paediatrics and so that I can develop new, better ways of doing things for my patients. 

Read Tom's paper - Validating clinical practice guidelines for the management of children with non-blanching rashes in the UK

The Donald Paterson award will be running again in 2023. Keep an eye out for more information.