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Clinical features suggestive of meningitis in children: a systematic review of prospective data

Sarah Curtis1, Kent Stobart, Ben Vandermeer

  • 1Division of Pediatric Emergency Medicine, University of Alberta, Edmonton, Alberta, Canada. scurtis@ualberta.ca

Pediatrics
|October 27, 2010
PubMed
Abstract

Insights

Accurate diagnosis of pediatric meningitis relies on recognizing key clinical features. While several signs increase suspicion, no single symptom definitively diagnoses pediatric bacterial meningitis.

Area of Science:

  • Pediatric Infectious Diseases
  • Clinical Diagnostics
  • Epidemiology

Background:

  • Accurate clinical diagnosis of pediatric meningitis is crucial for timely intervention.
  • Familiarity with evidence-based clinical features aids in identifying meningitis in children.

Purpose of the Study:

  • To systematically review and synthesize evidence on the accuracy of clinical features for diagnosing pediatric bacterial meningitis.
  • To identify specific signs and symptoms that increase or decrease the likelihood of pediatric meningitis.

Main Methods:

  • Comprehensive literature search across major databases (Medline, Embase, CINAHL, Web of Science, PubMed).
  • Inclusion of studies with prospective data on clinical features in children with confirmed bacterial meningitis versus controls.
  • Independent data extraction and quality assessment by two authors to calculate accuracy metrics (likelihood ratios).

Main Results:

  • Several historical features, including bulging fontanel and neck stiffness, significantly raised concern for meningitis.
  • On examination, jaundice, toxic appearance, meningeal signs, and fever >40°C were strong indicators.
  • Absence of meningeal signs and abnormal cry decreased the likelihood, while absence of fever did not rule out meningitis.

Conclusions:

  • Clinical features can significantly influence the diagnostic likelihood of pediatric meningitis.
  • No single clinical sign is sufficient for a definitive diagnosis; a combination of features is likely most accurate, though optimal combinations require further research.

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