In children and young people under 16 years of age, what symptoms and signs or combinations of symptoms and signs are predictive of bacterial meningitis?

Bibliographic informationReason for exclusion
J. Andersen, R. Christensen, and J. Hertel. Clinical features and epidemiology of septicaemia and meningitis in neonates due to Streptococcus agalactiae in Copenhagen County, Denmark: a 10 year survey from 1992 to 2001. Acta Paediatrica 93 (10):1334–1339, 2004This study does not report symptoms and signs separately for infants with meningitis. Most infants have septicaemia. Only 8 have meningitis.
C. O. Andersen. Streptococcus pneumoniae meningitis. Clinical and experimental studies. Danish Medical Bulletin 54 (3):189–209, 2007This study is a non systematic review with no new data.
M. Arditi, E. O. Mason, Jr., J. S. Bradley, T. Q. Tan, W. J. Barson, G. E. Schutze, E. R. Wald, L. B. Givner, K. S. Kim, R. Yogev, and S. L. Kaplan. Three-year multicenter surveillance of pneumococcal meningitis in children: clinical characteristics, and outcome related to penicillin susceptibility and dexamethasone use. Pediatrics 102 (5):1087–1097, 1998This study does not focus on symptoms and signs.
L. J. Baraff, S. A. Oslund, D. L. Schriger, and M. L. Stephen. Probability of bacterial infections in febrile infants less than three months of age: A meta-analysis. Pediatric Infectious Disease Journal 11 (4):257–265, 1992This study concerns the identification of serious bacterial illness.
A. Benderly, N. Shehadeh, Z. Grief, T. Hayek, P. Erde, and A. Etzioni. Bacterial meningitis in infants two to six weeks old. Helvetica Paediatrica Acta 41 (4):311–315, 1986This study is conducted in Israel. This setting does not satisfy the inclusion criteria for this review.
C. M. Benjamin, R. W. Newton, and M. A. Clarke. Risk factors for death from meningitis. British Medical Journal 296 (6614), 1988This study compares signs and symptoms in children who died of meningitis and those that survived – it does not compare signs and symptoms to non-meningitic controls.
A. Berardi, L. Lugli, D. Baronciani, R. Creti, K. Rossi, M. Ciccia, L. Gambini, S. Mariani, I. Papa, L. Serra, E. Tridapalli, F. Ferrari, and GBS Prevention Working Group of Emilia-Romagna. Group B streptococcal infections in a northern region of Italy. Pediatrics 120 (3):e487-e493, 2007This study does not report signs and symptoms separately for infants with meningitis.
S. Berg, B. Trollfors, K. Alestig, and U. Jodal. Incidence, serogroups and case-fatality rate of invasive meningococcal infections in a Swedish region 1975–1989. Scandinavian Journal of Infectious Diseases 24 (3):333–338, 1992This study does not focus on symptoms and signs.
J. Best and S. Hughes. Evidence behind the WHO Guidelines: hospital care for children--what are the useful clinical features of bacterial meningitis found in infants and children?. [23 refs]. Journal of Tropical Pediatrics 54 (2):83–86, 2008.This review focuses on studies from the developing world.
E. Bingen, C. Levy, E. Varon, Rocque F. de La, M. Boucherat, P. d'Athis, Y. Aujard, R. Cohen, and Bacterial Meningitis Study Group. Pneumococcal meningitis in the era of pneumococcal conjugate vaccine implementation. European Journal of Clinical Microbiology and Infectious Diseases 27 (3):191–199, 2008.This was a surveilance study of pneumococcal meningitis and thus did not address the clinical question.
W. A. Bonadio, W. Jeruc, Y. Anderson, and D. Smith. Systemic infection due to group B beta-hemolytic streptococcus in children. A review of 75 outpatient-evaluated cases during 13 years. Clinical Pediatrics 31 (4):230–233, 1992.This study did not separate neonates from older children, and did not match symptoms to outcome (meningitis vs other).
B. K. Bonsu and M. B. Harper. Fever interval before diagnosis, prior antibiotic treatment, and clinical outcome for young children with bacterial meningitis. Clinical Infectious Diseases 32 (4):566–572, 2001.This study does not focus on symptoms and signs.
R. Bortolussi, C. Krishnan, D. Armstrong, and P. Tovichayathamrong. Prognosis for survival in neonatal meningitis: clinical and pathologic review of 52 cases. Canadian Medical Association Journal 118 (2):165–168, 1978.This study doesn’t describe signs and symptoms of neonatal meningitis in detail. It focuses on prognostic factors. About half the infants are < 2500g and so are not relevant to the guideline population.
S. C. Buckingham, J. A. McCullers, J. Lujan-Zilbermann, K. M. Knapp, K. L. Orman, and B. K. English. Pneumococcal meningitis in children: relationship of antibiotic resistance to clinical characteristics and outcomes. Pediatric Infectious Disease Journal 20 (9):837–843, 2001.This study does not focus on signs and symptoms of meningitis at presentation. It does not address the clinical question.
H. Carstensen, J. Henrichsen, and O. B. Jepsen. A national survey of severe group B streptococcal infections in neonates and young infants in Denmark, 1978–83. Acta Paediatrica Scandinavica 74 (6):934–941, 1985.This study does not report signs and symptoms of neonatal meningitis in detail. It focuses on septicaemia caused by Group B Streptococcus.
S. Catania, M. P. Ronchetti, N. Catania, G. Berardelli, L. D'Aviera, F. Rossi, P. Mannozzi, S. Tzanzoglou, R. Bellagamba, and C. Ajassa. Hemophilus influenzae type b meningitis: pediatric overview. Rivista Europea Per Le Scienze Mediche e Farmacologiche 18 (4):163–167, 1996.This study looks at results of clinical tests rather than signs and symptoms.
R. F. Chin, B. G. Neville, C. Peckham, H. Bedford, A. Wade, R. C. Scott, and NLSTEPSS Collaborative Group. Incidence, cause, and short-term outcome of convulsive status epilepticus in childhood: prospective population-based study.[see comment]. Lancet 368 (9531):222–229, 2006.This study does not focus on symptoms and signs.
R. F. M. Chin, B. G. R. Neville, and R. C. Scott. Meningitis is a common cause of convulsive status epilepticus with fever. Archives of Disease in Childhood 90 (1):66–69, 2005.This study included childrren within our defined exclusion criteria, and had a small study population.
C. L. Cubells, GarciaJ Garcia, J. R. Martinez, and C. L. Otin. Clinical data in children with meningococcal meningitis in a Spanish hospital. Acta Paediatrica, International Journal of Paediatrics 86 (1):26–29, 1997This study concerns meningococcal disease and will have been reviewed as part of the meningococcal disease signs and symptoms review.
P. G. Davey, J. K. Cruikshank, I. C. McManus, B. Mahood, M. H. Snow, and A. M. Geddes. Bacterial meningitis--ten years experience. Journal of Hygiene 88 (3):383–401, 1982This study includes people of all ages. It does not report separate outcomes for children.
De Louvois J., J. Blackbourn, R. Hurley, and D. Harvey. Infantile meningitis in England and Wales: a two year study. Archives of Disease in Childhood 66 (5):603–607, 1991This study had insifficient detail about signs and symptoms.
F. Dubos, B. Lamotte, F. Bibi-Triki, F. Moulin, J. Raymond, D. Gendrel, G. Breart, and M. Chalumeau. Clinical decision rules to distinguish between bacterial and aseptic meningitis. Archives of Disease in Childhood 91 (8):647–650, 2006This study did not address the clinical question, and dis not separtaet neonates from older children.
D. W. Dunn. Status epilepticus in children: Etiology, clinical features, and outcome. Journal of Child Neurology 3 (3):167–173, 1988This study does not address the clinical question.
K. Fluegge, A. Siedler, B. Heinrich, J. Schulte-Moenting, M. J. Moennig, D. B. Bartels, O. Dammann, KriesR Von, and R. Berner. Incidence and clinical presentation of invasive neonatal group B streptococcal infections in Germany. Pediatrics 117 (6):e1139-e1145, 2006This study does not report signs and symptoms separately for infants with meningitis. It also does not focus on signs and symptoms.
P. J. Geiseler, K. E. Nelson, S. Levin, K. T. Reddi, and V. K. Moses. Community-acquired purulent meningitis: a review of 1,316 cases during the antibiotic era, 1954–1976. [86 refs]. Reviews of Infectious Diseases 2 (5):725–745, 1980This study includes people of all ages. It does not report separate outcomes for children.
P. J. Geiseler, K. E. Nelson, and S. Levin. Community-acquired purulent meningitis of unknown etiology. A continuing problem. Archives of Neurology 38 (12):749–753, 1981This study includes people of all ages. It does not report separate outcomes for children.
M. J. Goldacre. Neonatal meningitis. Postgraduate Medical Journal 53 (624):607–609, 1977This study does not describe signs and symptoms in detail. Two thirds of neonates develop meningitis whilst in hospital: not the guideline population of interest.
I. Gomes, A. Melo, R. Lucena, M. H. Cunha-Nascimento, A. Ferreira, J. Goes, I. Barreto, N. Jones, V. Gaspari, E. K. Embirucu, and M. Veiga. Prognosis of bacterial meningitis in children. Arquivos de Neuro-Psiquiatria 54 (3):407–411, 1996This study was conducted in Brazil and does not satisfy the inclusion criteria for this review.
S. M. Green, S. G. Rothrock, K. J. Clem, R. F. Zurcher, and L. Mellick. Can seizures be the sole manifestation of meningitis in febrile children? Pediatrics 92 (4):527–534, 1993This study focuses on the symptoms of seizure and only has data for bacterial memingitis. Better evidence was available elsewhere.
K. Grimwood, T. M. Nolan, L. Bond, V. A. Anderson, C. Catroppa, and E. H. Keir. Risk factors for adverse outcomes of bacterial meningitis. Journal of Paediatrics and Child Health 32 (5):457–462, 1996This study does not address the clinical question.
S. Hamada, M. Vearncombe, A. McGeer, and P. S. Shah. Neonatal group B streptococcal disease: incidence, presentation, and mortality. Journal of Maternal-Fetal and Neonatal Medicine 21 (1):53–57, 2008This study does not report signs and symptoms separately for neonates with meningitis.
G. R. Hodges and R. L. Perkins. Acute bacterial meningitis: an analysis of factors influencing prognosis. American Journal of the Medical Sciences 270 (3):427–440, 1975This study does not focus on symptoms and signs.
B. Hoen, J. F. Viel, A. Gerard, J. B. Dureux, and P. Canton. Mortality in pneumococcal meningitis: a multivariate analysis of prognostic factors. European Journal of Medicine 2 (1):28–32, 1993This study includes people of all ages and does not report outcomes separately for children.
It also does not address the clinical question.
S. Horenstein and D. J. Schreiber. Clinical features of bacterial meningitis. Advances in Neurology 6:141–159, 1974This is a narrative review.
A. Joffe, M. McCormick, and C. DeAngelis. Which children with febrile seizures need lumbar puncture? A decision analysis approach. American Journal of Diseases of Children 137 (12):1153–1156, 1983The population in this study was not the population of interest.
P. I. Kaaresen and T. Flaegstad. Prognostic factors in childhood bacterial meningitis. Acta Paediatrica 84 (8):873–878, 1995This study does not focus on symptoms and signs.
T. Kilpi, M. Anttila, M. J. Kallio, and H. Peltola. Severity of childhood bacterial meningitis and duration of illness before diagnosis. Lancet 338 (8764):406–409, 1991This study was exlcuded as better evidence was found elsewhere.
T. Kilpi, M. Anttila, M. J. Kallio, and H. Peltola. Length of prediagnostic history related to the course and sequelae of childhood bacterial meningitis. Pediatric Infectious Disease Journal 12 (3):184–188, 1993This study includes the same cohort of children studied in reference no 32370. It does not focus on symptoms and signs
B. A. King and P. Richmond. Pneumococcal meningitis: clinical course and resource use in Western Australian children. Journal of Paediatrics and Child Health 40 (11):606–610, 2004The study population includes a significant number of children with predisposing factors.
J. C. King, Jr., E. D. Berman, and P. F. Wright. Evaluation of fever in infants less than 8 weeks old. Southern Medical Journal 80 (8):948–952, 1987This study does not distinguish between mentingitis and meningococcal septicaemi.a
P. I. Klaaresen and T. Flaegstad. Prognostic factors in childhood bacterial meningitis. Acta Paediatrica, International Journal of Paediatrics 84 (8):873–878, 1995This study does not focus on signs and symptoms.
R. M. Laxer and M. I. Marks. Pneumococcal meningitis in children. American Journal of Diseases of Children 131 (8):850–853, 1977This study does not focus sufficiently on presenting symptoms and signs.
M. Levy, E. Wong, and D. Fried. Diseases that mimic meningitis. Analysis of 650 lumbar punctures. Clinical Pediatrics 29 (5):254–261, 1990This study is conducted in Israel. This setting does not satisfy the inclusion criteria for this review.
J. Lorber and R. Sunderland. Lumbar puncture in children with convulsions associated with fever. Lancet 1 (8172):785–786, 1980This study does not address the clinical question.
Cubells C. Luaces, J. J. Garcia Garcia, Martinez J. Roca, and C. L. Latorre Otin. Clinical data in children with meningococcal meningitis in a Spanish hospital. Acta Paediatrica 86 (1):26–29, 1997This study was only about meningococcal meningitis, not sepsis or bacterial meningitis.
L. E. Nigrovic, N. Kuppermann, and R. Malley. Development and validation of a multivariable predictive model to distinguish bacterial from aseptic meningitis in children in the post-Haemophilus influenzae era.[see comment]. Pediatrics 110 (4):712–719, 2002This study did not distinguish between neonates and older children and did not address the clinical question.
L. E. Nigrovic, N. Kuppermann, C. G. Macias, C. R. Cannavino, D. M. Moro-Sutherland, R. D. Schremmer, S. H. Schwab, D. Agrawal, K. M. Mansour, J. E. Bennett, Y. L. Katsogridakis, M. M. Mohseni, B. Bulloch, D. W. Steele, R. L. Kaplan, M. I. Herman, S. Bandyopadhyay, P. Dayan, U. T. Truong, V. J. Wang, B. K. Bonsu, J. L. Chapman, J. T. Kanegaye, R. Malley, and Pediatric Emergency Medicine Collaborative Research Committee of the American Academy of Pediatrics. Clinical prediction rule for identifying children with cerebrospinal fluid pleocytosis at very low risk of bacterial meningitis.[see comment]. JAMA 297 (1):52–60, 2007This study gives the results of a scoring system for the risk of bacterial meningitis, and some information on CSF findings. It does not report the incidence of specific signs and symptoms.
B. Nielsen, H. T. Sorensen, and J. O. Nielsen. Children admitted for observation for suspected meningitis. Problems in diagnosis in general practice. Scandinavian Journal of Primary Health Care 6 (4):229–232, 1988This study had a small number of cases and there was better evidence elsewhere.
M. Offringa, A. Beishuizen, G. rksen-Lubsen, and J. Lubsen. Seizures and fever: can we rule out meningitis on clinical grounds alone? Clinical Pediatrics 31 (9):514–522, 1992This study does not address the clinical question, and better evidence was found elsewhere.
R. Oostenbrink, K. G. Moons, C. C. Theunissen, G. rksen-Lubsen, D. E. Grobbee, and H. A. Moll. Signs of meningeal irritation at the emergency department: how often bacterial meningitis? Pediatric Emergency Care 17 (3):161–164, 2001The study did not answer the clinical question.
R. Oostenbrink, K. G. Moons, A. R. Donders, D. E. Grobbee, and H. A. Moll. Prediction of bacterial meningitis in children with meningeal signs: reduction of lumbar punctures. Acta Paediatrica 90 (6):611–617, 2001Better evidience was found elswhere.
R. Oostenbrink, K. G. Moons, M. J. Twijnstra, D. E. Grobbee, and H. A. Moll. Children with meningeal signs: predicting who needs empiric antibiotic treatment.[see comment]. Archives of Pediatrics and Adolescent Medicine 156 (12):1189–1194, 2002This study looked at developing a decision rule based on clinical signs. Details of the frequency of individual clinical signs was provided for children with indication for lumbar puncture, but it is not reported how many of these were confirmed bacterial meningitis cases.
R. Oostenbrink, J. B. Oostenbrink, K. G. Moons, G. rksen-Lubsen, M. L. Essink-Bot, D. E. Grobbee, W. K. Redekop, and H. A. Moll. Cost-utility analysis of patient care in children with meningeal signs. International Journal of Technology Assessment in Health Care 18 (3):485–496, 2002This study does not address the clinical question.
R. Oostenbrink, J. B. Oostenbrink, K. G. Moons, G. rksen-Lubsen, D. E. Grobbee, W. K. Redekop, and H. A. Moll. Application of a diagnostic decision rule in children with meningeal signs: a cost-minimization study. International Journal of Technology Assessment in Health Care 19 (4):698–704, 2003This study does not address the clinical question.
R. Oostenbrink, K. G. Moons, A. G. rksen-Lubsen, D. E. Grobbee, and H. A. Moll. A diagnostic decision rule for management of children with meningeal signs.[erratum appears in Eur J Epidemiol. 2004;19(12):1137 Note: Moons, Carl GM [corrected to Moons, Karel GM]]. European Journal of Epidemiology 19 (2):109–116, 2004This was the same cohort as in Oostenbrink et al (2002) {46009}. Details of the frequency of individual clinical signs was provided for children with indication for lumbar puncture, but it is not reported how many of these were confirmed bacterial meningitis cases.
C. Ostergaard, N. Hoiby, H. B. Konradsen, and S. Samuelsson. Prehospital diagnostic and therapeutic management of otogenic Streptococcus pneumoniae meningitis. Scandinavian Journal of Infectious Diseases 38 (3):172–180, 2006This is not the population of interest.
P. Pagliano, U. Fusco, V. Attanasio, M. Rossi, A. Pantosti, M. Conte, and F. S. Faella. Pneumococcal meningitis in childhood: a longitudinal prospective study. FEMS Immunology and Medical Microbiology 51 (3):488–495, 2007This study looks at influence of clinical factors on outcome and therefore does not answer the clinical question.
R. H. Pantell, T. B. Newman, J. Bernzweig, D. A. Bergman, J. I. Takayama, M. Segal, S. A. Finch, and R. C. Wasserman. Management and outcomes of care of fever in early infancy.[see comment]. JAMA 291 (10):1203–1212, 2004This practice based study was conducted in the USA and Columbia and Puerto Rico. It does not address menigococcal septicaemia, and better evidence was available elsewhere.
M. S. Parkinson. Early recognition of symptoms in childhood meningitis. Practitioner 209 (250):191–195, 1972This study was conducted in 1972 and thus is ‘old data’ (pre-pneumovax). Better evidence was found elsewhere.
S. A. Phillips and R. J. Shanahan. Etiology and mortality of status epilepticus in children. A recent update. Archives of Neurology 46 (1):74–76, 1989This study does not address the clinical question.
S. L. Pomeroy, S. J. Holmes, P. R. Dodge, and R. D. Feigin. Seizures and other neurologic sequelae of bacterial meningitis in children. New England Journal of Medicine 323 (24):1651–1657, 1990This study does not address the clinical question.
S. Press. Association of hyperpyrexia with serious disease in children. Clinical Pediatrics 33 (1):19–25, 1994This study does not sufficiently focus on signs and symptoms.
L. Ragunathan, M. Ramsay, R. Borrow, M. Guiver, S. Gray, and E. B. Kaczmarski. Clinical features, laboratory findings and management of meningococcal meningitis in England and Wales: report of a 1997 survey. Meningococcal meningitis: 1997 survey report. Journal of Infection 40 (1):74–79, 2000This study does not provide data that is clinically useful.
J. C. Ratcliffe and S. M. Wolf. Febrile convulsions caused by meningitis in young children. Annals of Neurology 1 (3):285–286, 1977This study did not address the clinical question, focusing acutely on seizures.
I. Roine, H. Peltola, J. Fernandez, I. Zavala, A. G. Mata, S. G. Ayala, A. Arbo, R. Bologna, G. Mino, J. Goyo, E. Lopez, AndradeS De, and S. Sarna. Influence of admission findings on death and neurological outcome from childhood bacterial meningitis. Clinical Infectious Diseases 46 (8):1248–1252, 2008This study does not address the clinical question.
F. K. Romer. Difficulties in the diagnosis of bacterial meningitis. Evaluation of antibiotic pretreatment and causes of admission to hospital. Lancet 2 (8033):345–347, 1977This study includes people of all ages and does not report outcomes separately for children.
N. M. Rosenberg and T. Bobowski. Clinical indicators for lumbar puncture. Pediatric Emergency Care 4 (1):5–8, 1988This study does not address the clinical question.
N. M. Rosenberg, K. Meert, D. Marino, and Baker K. De. Seizures associated with meningitis.[see comment]. Pediatric Emergency Care 8 (2):67–69, 1992This study does not address the clinical question.
N. P. Rosman, D. B. Peterson, E. M. Kaye, and T. Colton. Seizures in bacterial meningitis: prevalence, patterns, pathogenesis, and prognosis. Pediatric Neurology 1 (5):278–285, 1985This study was conducted before the introduction of the Pneumovax (pneumococcal vaccine) and thus is considered old data.
L. N. Rossi, G. Brunelli, N. Duzioni, and G. Rossi. Lumbar puncture and febrile convulsions. Helvetica Paediatrica Acta 41 (1- ):19–24, 1986This study looks at the use of lumbar puncture in diagnosing bactieral meningitis. Clinical signs and symptoms are not reported.
S. G. Rothrock, S. M. Green, J. Wren, D. Letai, L. niel-Underwood, and E. Pillar. Pediatric bacterial meningitis: is prior antibiotic therapy associated with an altered clinical presentation? Annals of Emergency Medicine 21 (2):146–152, 1992This study compares the signs and symptoms of children who receive pre-hospital antibiotics and those that do not.
J. H. Samson, J. Apthorp, and A. Finley. Febrile seizures and purulent meningitis. JAMA 210 (10):1918–1919, 1969This paper is from 1969 and more recent research is available.
L. C. Santos, J. Simoes, M. Severo, J. Vazquez, and H. Lecour. Bacterial meningitis in an urban area: etiologic study and prognostic factors. Infection 35 (6):406–413, 2007This study population was not relevant (included adults).
D. A. Talan and J. Zibulewsky. Relationship of clinical presentation to time to antibiotics for the emergency department management of suspected bacterial meningitis. Annals of Emergency Medicine 22 (11):1733–1738, 1993This study includes people of all ages and does not report outcomes separately for children.
M. Tucci, M. H. Lebel, M. Gauthier, C. A. Farrell, and J. Lacroix. Admission to a pediatric intensive care unit for bacterial meningitis: Review of 168 cases. Journal of Intensive Care Medicine 10 (5):253–260, 1995This study does not address the clinical question.
M. Unhanand, M. M. Mustafa, G. H. McCracken, Jr., and J. D. Nelson. Gram negative enteric bacillary meningitis: a twenty-one-year experience. Journal of Pediatrics 122 (1):15–21, 1993This study had small numbers and a significant number of the study population has predisposing factors.
Nguyen Q. Van, E. A. Nguyen, and L. B. Weiner. Incidence of invasive bacterial disease in children with fever and petechiae. Pediatrics 74 (1):77–80, 1984This study was retrospective and the only outcome was bacterial sepsis with no differentiation between meningitis and sepsis.
T. E. Wiswell, S. Baumgart, C. M. Gannon, and A. R. Spitzer. No lumbar puncture in the evaluation for early neonatal sepsis: will meningitis be missed?[see comment]. Pediatrics 95 (6):803–806, 1995.This study does not look at signs and symptoms.
Batajoo J, Rayamajhi A, Mahaseth C. Children with first episode of fever with seizure: is lumbar puncture necessary?Does not answer clinical question.
Ghotbi H, Shiva f. An assessment of the necessity of lumbar puncture in children with seizure and fever.Study done in Iran – we’re only looking at high income countries for this question.
Finkelstein JA, Christiansen CL and Platt R. Fever in pediatric care: occurrence, management and outcomes. Pediatrics 105 260–266 (2000)Does not address meningitis in detail, only with a limited number of case studies.
Conicella E, Raucci U, Vanacore N, Vigevano F, etc. The child with headache in a pediatric emergency department. Headache 2008 48 p1005–1011Does not address meningitis.
Kimia AA, Capraro AJ, Hummel D et al. Utility of lumbar puncture for first simple febrile seizure among children 6 to 18 months of age. Pediatrics 2009This study looks at the incidence of febrile seizures, but does not report how many of the patients had bacterial meningitis.
Gopal AK, Whitehouse JD, Simel DL et al. Cranial computed tomography before lumbar puncture. (1999) Arch Intern Med vol 159 p2681–2685This study only looks at lumbar puncture in adults and does not look specifically at those with bacterial meningitis.
Haworth JC. The diagnosis of acute meningitis in infancy. The Lancet vol 9 (May) p911–914 (1953)This paper is from 1953 and more recent research is available.
Jones L, Clarke J, Riordan FAI. Validation of an algorithm for managing children with a non-blanching rash. Arch Dis Child 2004;89 Sup 1:A1This paper has been excluded as it was only available in abstract form.

From: Appendix F, Excluded studies

Cover of Bacterial Meningitis and Meningococcal Septicaemia
Bacterial Meningitis and Meningococcal Septicaemia: Management of Bacterial Meningitis and Meningococcal Septicaemia in Children and Young People Younger than 16 Years in Primary and Secondary Care.
NICE Clinical Guidelines, No. 102.
National Collaborating Centre for Women's and Children's Health (UK).
London: RCOG Press; 2010.
Copyright © 2010, Royal College of Obstetricians and Gynaecologists.

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