Clinical Features Suggestive of Meningitis in Children: A Systematic Review of Prospective Data
- 1 November 2010
- journal article
- review article
- Published by American Academy of Pediatrics (AAP) in PEDIATRICS
- Vol. 126 (5), 952-960
- https://doi.org/10.1542/peds.2010-0277
Abstract
CONTEXT: Clinical diagnosis of pediatric meningitis is fundamental; therefore, familiarity with evidence underscoring clinical features suggestive of meningitis is important. OBJECTIVE: To seek evidence supporting accuracy of clinical features of pediatric bacterial meningitis. METHODS: A review of Medline, Embase, the Cumulative Index to Nursing and Allied Health Literature, Web of Science, and PubMed was conducted for all articles of relevance. Articles contained prospective data of clinical features in children with laboratory-confirmed bacterial meningitis and in comparison groups of those without it. Two authors independently assessed quality and extracted data to calculate accuracy data of clinical features. RESULTS: Of 14 145 references initially identified, 10 met our inclusion criteria. On history, a report of bulging fontanel (likelihood ratio [LR]: 8.00 [95% confidence interval (CI): 2.4–26]), neck stiffness (7.70 [3.2–19]), seizures (outside febrile-convulsion age range) (4.40 [3.0–6.4]), or reduced feeds (2.00 [1.2–3.4]) raised concern about the presence of meningitis. On examination, jaundice (LR: 5.90 [95% CI: 1.8–19]), being toxic or moribund (5.80 [3.0–11]), meningeal signs (4.50 [2.4–8.3]), neck stiffness (4.00 [2.6–6.3]), bulging fontanel (3.50 [2.0–6.0]), Kernig sign (3.50 [2.1–5.7]), tone up (3.20 [2.2–4.5]), fever of >40°C (2.90 [1.6–5.5]), and Brudzinski sign (2.50 [1.8–3.6]) independently raised the likelihood of meningitis. The absence of meningeal signs (LR: 0.41 [95% CI: 0.30–0.57]) and an abnormal cry (0.30 [0.16–0.57]) independently lowered the likelihood of meningitis. The absence of fever did not rule out meningitis (LR: 0.70 [95% CI: 0.53–0.92]). CONCLUSIONS: Evidence for several useful clinical features that influence the likelihood of pediatric meningitis exists. No isolated clinical feature is diagnostic, and the most accurate diagnostic combination is unclear.Keywords
This publication has 23 references indexed in Scilit:
- Overconfidence in Clinical Decision MakingAmerican Journal Of Medicine, 2008
- Overconfidence as a Cause of Diagnostic Error in MedicineAmerican Journal Of Medicine, 2008
- Acute bacterial meningitis among children, in Manhiça, a rural area in Southern MozambiqueActa Tropica, 2008
- Malpractice Claims Involving Pediatricians: Epidemiology and EtiologyPEDIATRICS, 2007
- Five pitfalls in decisions about diagnosis and prescribingBMJ, 2005
- Measuring inconsistency in meta-analysesBMJ, 2003
- Understanding our mistakes: a primer on errors in clinical reasoningMedical Teacher, 2003
- Simplifying likelihood ratiosJournal of General Internal Medicine, 2002
- Clinical predictors of bacterial versus aseptic meningitis in childhoodAnnals of Emergency Medicine, 1992