Journal ArticleDOI
Clinical Features Suggestive of Meningitis in Children: A Systematic Review of Prospective Data
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TLDR
Evidence for several useful clinical features that influence the likelihood of pediatric meningitis exists.Abstract:
CONTEXT: Clinical diagnosis of pediatric meningitis is fundamental; therefore, familiarity with evidence underscoring clinical features suggestive of meningitis is important. OBJECTIVE: To seek evidence supporting accuracy of clinical features of pediatric bacterial meningitis. METHODS: A review of Medline, Embase, the Cumulative Index to Nursing and Allied Health Literature, Web of Science, and PubMed was conducted for all articles of relevance. Articles contained prospective data of clinical features in children with laboratory-confirmed bacterial meningitis and in comparison groups of those without it. Two authors independently assessed quality and extracted data to calculate accuracy data of clinical features. RESULTS: Of 14 145 references initially identified, 10 met our inclusion criteria. On history, a report of bulging fontanel (likelihood ratio [LR]: 8.00 [95% confidence interval (CI): 2.4–26]), neck stiffness (7.70 [3.2–19]), seizures (outside febrile-convulsion age range) (4.40 [3.0–6.4]), or reduced feeds (2.00 [1.2–3.4]) raised concern about the presence of meningitis. On examination, jaundice (LR: 5.90 [95% CI: 1.8–19]), being toxic or moribund (5.80 [3.0–11]), meningeal signs (4.50 [2.4–8.3]), neck stiffness (4.00 [2.6–6.3]), bulging fontanel (3.50 [2.0–6.0]), Kernig sign (3.50 [2.1–5.7]), tone up (3.20 [2.2–4.5]), fever of >40°C (2.90 [1.6–5.5]), and Brudzinski sign (2.50 [1.8–3.6]) independently raised the likelihood of meningitis. The absence of meningeal signs (LR: 0.41 [95% CI: 0.30–0.57]) and an abnormal cry (0.30 [0.16–0.57]) independently lowered the likelihood of meningitis. The absence of fever did not rule out meningitis (LR: 0.70 [95% CI: 0.53–0.92]). CONCLUSIONS: Evidence for several useful clinical features that influence the likelihood of pediatric meningitis exists. No isolated clinical feature is diagnostic, and the most accurate diagnostic combination is unclear.read more
Citations
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Journal ArticleDOI
ESCMID guideline: diagnosis and treatment of acute bacterial meningitis.
D. van de Beek,C Cabellos,Olga Dzupova,Susanna Esposito,Matthias Klein,Anne T. Kloek,Stephen L. Leib,Bruno Mourvillier,Christian Østergaard,Pasquale Pagliano,Hans-Walter Pfister,Robert C. Read,O Resat Sipahi,Mieke C. Brouwer +13 more
TL;DR: The ESCMID Study Group for Infections of the Brain (ESGIB) is a large-scale, randomized, placebo-controlled study that aims to provide real-time information on the safe and effective use of antibiotics in the treatment of central nervous system disorders.
Journal ArticleDOI
Dilemmas in the diagnosis of acute community-acquired bacterial meningitis
TL;DR: The dilemmas in the diagnosis of acute community-acquired bacterial meningitis are reviewed, and the roles of clinical assessment and CSF examination are focused on.
Journal ArticleDOI
Clinical prediction model to aid emergency doctors managing febrile children at risk of serious bacterial infections: diagnostic study
Ruud G. Nijman,Yvonne Vergouwe,Matthew Thompson,Mirjam van Veen,Alfred H J van Meurs,Johan van der Lei,Ewout W. Steyerberg,Henriëtte A. Moll,Rianne Oostenbrink +8 more
TL;DR: A validated prediction model, including clinical signs, symptoms, and C reactive protein level, was useful for estimating the likelihood of pneumonia and other SBIs in children with fever, such as septicaemia/meningitis and urinary tract infections.
Journal ArticleDOI
Central Nervous System Infections
David Somand,William J. Meurer +1 more
TL;DR: The changing pattern and epidemiology of a variety of common central nervous system infections, including meningitis, encephalitis, and brain abscesses are described and pathophysiology and the most current approach to clinical diagnosis, treatment, and disposition from the emergency physician perspective are reviewed.
Journal ArticleDOI
A proposal for distinguishing between bacterial and viral meningitis using genetic programming and decision trees
TL;DR: This work considers two distinct cases of meningitis, and takes into account both blood and cerebrospinal parameters, resulting in rules and formulas applicable in clinical settings that achieve 100% of sensitivity in detecting a bacterial meneditis.
References
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Eta S. Berner,Mark L. Graber +1 more
TL;DR: It is argued that physicians in general underappreciate the likelihood that their diagnoses are wrong and that this tendency to overconfidence is related to both intrinsic and systemically reinforced factors.
Journal ArticleDOI
Simplifying Likelihood Ratios
TL;DR: This article describes a simpler method of interpreting likelihood ratios, one that avoids calculators, nomograms, and conversions to “odds” of disease.