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Review: the physical examination can exclude the diagnosis of meningitis in low-risk adults

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 QUESTION: What is the sensitivity of specific features of the clinical history and physical examination for diagnosing meningitis in immunocompetent adults?

Data sources

Studies were identified by searching Medline (1966 to July 1997) using terms related to physical examination, meningitis, and diagnostic test properties and scanning bibliographies of relevant articles.

Study selection

English and French studies of adults were selected if they assessed the sensitivity of various features of the clinical history or physical examination for the diagnosis of meningitis and if most of the patients had objectively confirmed bacterial or viral meningitis.

Data extraction

Data were extracted on the clinical setting, years of data collection, number and characteristics of the patients and patient episodes, how patients were identified, type of meningitis, clinical history (headache, nausea and vomiting, and …

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  • Source of funding: no external funding.

  • For correspondence: Dr R Hatala, 4th Floor, McMaster Building, Henderson Hospital, 711 Concession Street, Hamilton, Ontario L8V 1C3, Canada. FAX 905-575-7320.