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Ann Emerg Med. 1992 Aug;21(8):910-4.

Clinical predictors of bacterial versus aseptic meningitis in childhood.

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1
Department of Pediatrics, Medical College of Wisconsin, Children's Hospital of Wisconsin, Milwaukee.

Abstract

STUDY OBJECTIVE:

To assess the reliability of meningeal signs and other physical findings in predicting bacterial and aseptic meningitis at various ages.

DESIGN:

Children requiring lumbar puncture were evaluated prospectively for meningeal signs and other physical parameters before lumbar puncture.

SETTING:

Emergency department of Children's Hospital of Wisconsin.

PARTICIPANTS:

One hundred seventy-two children, aged 1 week to 17 years, with meningitis (53 bacterial and 119 aseptic).

MEASUREMENTS AND MAIN RESULTS:

Nuchal rigidity was present in 27% of infants aged 0 to 6 months with bacterial meningitis versus 95% of patients 19 months or older (P = .0001). Three percent of infants 0 to 6 months old with aseptic meningitis had nuchal rigidity versus 79% of patients 19 months or older (P = .0005). Seventy-two percent of infants 12 months of age or younger with bacterial meningitis has at least one positive meningeal sign versus 17% of infants with aseptic meningitis (P = .0001). Eighty-five percent of children older than 12 months with meningitis had at least one positive meningeal sign, 93% with bacterial meningitis, and 82% with aseptic meningitis.

CONCLUSION:

Despite a lack of meningeal signs, a high index of suspicion for meningitis is essential when evaluating the febrile infant 12 months of age or younger.

PMID:
1497155
[Indexed for MEDLINE]
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