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Systematic review with meta-analysis
Several clinical signs and symptoms are associated with the likelihood of bacterial meningitis in children; the most reliable diagnostic combination is uncertain
  1. David G Bundy
  1. Johns Hopkins University School of Medicine and Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
  1. Correspondence to David G Bundy
    200 North Wolfe Street, Rubenstein Child Health Building, Room 2095, Baltimore, MD, 21287, USA; dbundy{at}

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Despite large-scale, vaccine-based preventive efforts, bacterial meningitis remains an important cause of paediatric morbidity and mortality worldwide.1 2 Definitive diagnosis of meningitis requires a lumbar puncture (LP), which is invasive and technically challenging, particularly in children. Further, the means to analyse the resulting cerebrospinal fluid sample are not universally available.

Clinicians frequently confront a child with symptoms or signs concerning for meningitis. Providers rely on the medical history and physical examination to determine whether additional diagnostic and treatment measures are indicated. The utility of symptoms and signs for identifying a subgroup of children at elevated risk for bacterial meningitis, however, is unclear.


The authors conducted a systematic review of studies evaluating the historical and physical examination features of children with LP-confirmed bacterial meningitis, compared to children in whom the diagnosis of bacterial meningitis was considered but subsequently excluded by LP. Candidate studies were scored …

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  • Competing interests None.