Classic Clinical Indicators of Meningitis in Children Have Limited Diagnostic Utility

Investigators prospectively assessed the diagnostic accuracy of classic signs and symptoms of meningitis in 108 children (age range, 2 months to 16 years) who underwent lumbar puncture for clinically suspected meningitis at two emergency departments in Israel between 2006 and 2007. Fifty-eight patients received diagnoses of meningitis, defined as cerebrospinal fluid white blood cell count ≥6/µL.

Individual signs and symptoms had the following sensitivities and specificities, respectively, for meningitis:

• Headache (in verbal patients): 76% and 53%

• Vomiting or nausea: 71% and 62%

• Photophobia: 28% and 88%

• Motor deficiency: 3% and 98%

• Seizures: 19% and 64%

• Rectal temperature >38°C: 93% and 8%

• Glasgow Coma Scale (GCS) score <13: 9% and 92%

• Nuchal rigidit…