J Korean Child Neurol Soc.  2004 Nov;12(2):169-175.

The Diagnostic Accuracy of Neurologic Signs in Children Suspected of Meningitis

• Kim MJ
• Moon KR
• Rho YI

Abstract

OBJECTIVE
The primary purpose of the present study is to determine the diagnostic accuracy of Kernig's sign, Brudzinski's sign, nuchal rigidity, and Jolt accentuation of headache for children suspected of meningitis. This study focuses on the clinical symptoms and signs of meningeal irritation and their relationship to the CSF pleocytosis.
METHODS
We examined these meningeal irritation signs before lumbar puncture from the patients who visited Chosun University Hospital and were suspected of meningitis.
RESULTS
A total of 70 children(age>4) were enrolled over 12 months. Kernig's sign (sensitivity : 41%, specificity : 77%), neck stiffness(sensitivity : 76%, specificity : 41%), and Jolt accentuation of headache(sensitivity : 76%, specificity : 48%) did not accurately discriminate the patients with meningitis(> or =6 white blood cells/mL of CSF) from the patients without meningitis. But Brudzinski's sign(sensitivity : 64%, specificity : 70%, P< 0.05) was valuable to predict the CSF pleocytosis. Among the clinical symptoms, nausea, vomiting, fever and headache(P<0.05) were shown to have diagnostic values.
CONCLUSION
The objectification of neurologic sign is demanded and better bedside diagnostic tests are needed.

Keyword

Kernig's sign; Brudzinski's sign; Nuchal rigidity; Jolt accentuation of headache; Meningitis

MeSH Terms

Child*
Diagnostic Tests, Routine
Fever
Headache
Humans
Leukocytosis
Meningitis*
Muscle Rigidity
Nausea
Neck
Neurologic Manifestations*
Sensitivity and Specificity
Spinal Puncture
Vomiting