Clinical predictors of bacterial versus aseptic meningitis in childhood

Christine Walsh-Kelly, David B. Nelson, Douglas S. Smith, Joseph D. Losek, Marlene Melzer-Lange, Halim M. Hennes, Peter W. Glaeser

Research output: Contribution to journalArticle

23 Scopus citations

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 had 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.

Original languageEnglish (US)
Pages (from-to)910-914
Number of pages5
JournalAnnals of Emergency Medicine
Volume21
Issue number8
DOIs
StatePublished - Aug 1992

Keywords

  • meningitis, aseptic
  • meningitis, bacterial

ASJC Scopus subject areas

  • Emergency Medicine

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    Walsh-Kelly, C., Nelson, D. B., Smith, D. S., Losek, J. D., Melzer-Lange, M., Hennes, H. M., & Glaeser, P. W. (1992). Clinical predictors of bacterial versus aseptic meningitis in childhood. Annals of Emergency Medicine, 21(8), 910-914. https://doi.org/10.1016/S0196-0644(05)82926-9