title: Clinical predictors of bacterial meningitis in infants and young children in The Gambia.
abstract: BACKGROUND
  Bacterial meningitis is an important cause of childhood morbidity and mortality world-wide. In the developing world, where the burden of acute meningitis and its long-term sequelae are especially high, staff with limited training at primary health care facilities must be able to recognize the symptoms and signs of meningitis, so that suspected cases can be referred urgently to hospitals.
  
  
  METHODS
  Children who presented with possible invasive bacterial infection to health facilities in The Gambia, West Africa, between 1993 and 1995 were investigated in a standardized manner and clinical findings were documented. Bacterial meningitis was defined as the growth of bacteria from the cerebrospinal fluid. Clinical findings were compared between cases of meningitis and other children.
  
  
  RESULTS
  Of 2097 children between 2 months and 3 years of age investigated, 51 had a confirmed diagnosis of bacterial meningitis. In multivariate analysis using a model adjusting for age but not including respiratory signs, the variables associated independently with meningitis were appearance of being very sick (odds ratio for meningitis vs. no meningitis or no lumbar puncture performed (OR) 4.1, 95% CI 1.5-11.1), being lethargic or unconscious (OR 5.2, 95% CI 2.1-13), a stiff neck (OR 29.3, 95% CI 12.2-70.3), a bulging fontanel (OR 3.2, 95% CI 1.2-8.5) and reduced feeding as a prompted complaint (OR 2.9, 95% CI 1.3-6.7). A combination model of a history of convulsions, or being lethargic or unconscious, or having a stiff neck, as used in the WHO-Integrated Management of Childhood Illness (IMCI) guidelines, had a sensitivity of 98% and a specificity of 72% to predict meningitis.
  
  
  CONCLUSIONS
  A combination of a limited number of signs is sufficient to predict meningitis with high sensitivity, without a large number of children who do not have meningitis being unnecessarily referred.
authors.affiliation: Medical Research Council Laboratories, Fajara, The Gambia. weberm@who.int
authors.forename: Martin W
authors.initials: MW
authors.lastname: Weber
authors.forename: Joanna
authors.initials: J
authors.lastname: Herman
authors.forename: Shabbar
authors.initials: S
authors.lastname: Jaffar
authors.forename: Stanley
authors.initials: S
authors.lastname: Usen
authors.forename: Anslem
authors.initials: A
authors.lastname: Oparaugo
authors.forename: Charles
authors.initials: C
authors.lastname: Omosigho
authors.forename: Richard A
authors.initials: RA
authors.lastname: Adegbola
authors.forename: Brian M
authors.initials: BM
authors.lastname: Greenwood
authors.forename: E Kim
authors.initials: EK
authors.lastname: Mulholland
mesh_terms: D002675:Child, Preschool; D005260:Female; D005714:Gambia / Q000453:epidemiology; D006193:Haemophilus influenzae / Q000302:isolation & purification; D006801:Humans; D007223:Infant; D008297:Male; D016920:Meningitis, Bacterial / Q000134:cerebrospinal fluid / Q000175:diagnosis* / Q000382:microbiology / Q000401:mortality* / Q000473:pathology; D010808:Physical Examination / Q000592:standards*; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D013296:Streptococcus pneumoniae / Q000302:isolation & purification; D011795:Surveys and Questionnaires / Q000592:standards*; D014944:World Health Organization