Physical Signs of Meningitis: Classics, but Useful?

Acute bacterial meningitis is a potentially lethal infection that requires rapid diagnosis and treatment by emergency department (ED) personnel. Presence or absence of classic physical . . .

Acute bacterial meningitis is a potentially lethal infection that requires rapid diagnosis and treatment by emergency department (ED) personnel. Presence or absence of classic physical signs of meningitis is often used in deciding whether a patient warrants a diagnostic lumbar puncture (LP). But how reliable are these signs as predictors of meningitis?

ED personnel at an academic medical center confirmed clinically suspected meningitis by LP (>6 white blood cells/mL CSF) in 80 of 297 patients at an academic medical center ED; 29 had ≥100 cells/mL, and 4 had ≥1000 cells/mL. ED examiners (28% interns, 55% residents, and 17% attending physicians) observed Brudzinski's or Kernig's sign in 7 of 236 and 7 of 237 patients, respectively. Four patien…

Reviewing Author

Bradley E. Britigan, MD