Walsh-Kelly C, Nelson D B, Smith D S, Losek J D, Melzer-Lange M, Hennes H M, Glaeser P W
Department of Pediatrics, Medical College of Wisconsin, Children's Hospital of Wisconsin, Milwaukee.
Ann Emerg Med. 1992 Aug;21(8):910-4. doi: 10.1016/s0196-0644(05)82926-9.
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 has 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.
评估脑膜刺激征及其他体格检查结果在预测不同年龄段细菌性和无菌性脑膜炎方面的可靠性。
对需要进行腰椎穿刺的儿童在腰穿前对脑膜刺激征和其他体格参数进行前瞻性评估。
威斯康星儿童医院急诊科。
172名年龄在1周龄至17岁的患有脑膜炎的儿童（53例细菌性脑膜炎和119例无菌性脑膜炎）。
0至6个月的细菌性脑膜炎婴儿中27%存在颈项强直，而19个月及以上患者中这一比例为95%（P = 0.0001）。0至6个月的无菌性脑膜炎婴儿中有3%存在颈项强直，而19个月及以上患者中这一比例为79%（P = 0.0005）。12个月及以下的细菌性脑膜炎婴儿中有72%至少有一项脑膜刺激征阳性，而无菌性脑膜炎婴儿中这一比例为17%（P = 0.0001）。12个月以上患有脑膜炎的儿童中有85%至少有一项脑膜刺激征阳性，其中细菌性脑膜炎患者中这一比例为93%，无菌性脑膜炎患者中这一比例为82%。
尽管缺乏脑膜刺激征，但在评估12个月及以下的发热婴儿时，对脑膜炎保持高度怀疑指数至关重要。
