Clinical predictors of bacterial versus aseptic meningitis in childhood

To assess the reliability of meningeal signs and other physical findings in predicting bacterial and aseptic meningitis at various ages. Children requiring lumbar puncture were evaluated prospectively for meningeal signs and other physical parameters before lumbar puncture. Emergency department of Children's Hospital of Wisconsin. One hundred seventy-two children, aged 1 week to 17 years, with meningitis (53 bacterial and 119 aseptic). Nuchal rigidity was present in 27% of infants aged 0 to 6 months with bacterial meningitis versus 95% of patients 19 months or older ( P = .0001). Three percent of infants 0 to 6 months old with aseptic meningitis had nuchal rigidity versus 79% of patients 19 months or older ( P = .0005). Seventy-two percent of infants 12 months of age or younger with bacterial meningitis had at least one positive meningeal sign versus 17% of infants with aseptic meningitis ( P = .0001). Eighty-five percent of children older than 12 months with meningitis had at least one positive meningeal sign, 93% with bacterial meningitis, and 82% with aseptic meningitis. Despite a lack of meningeal signs, a high index of suspicion for meningitis is essential when evaluating the febrile infant 12 months of age or younger.