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Journal of the Korean Child Neurology Society 2004;12(2):169-175.
Published online November 30, 2004.
The Diagnostic Accuracy of Neurologic Signs in Children Suspected of Meningitis.
Mi Jin Kim, Kyung Rye Moon, Young Il Rho
Departments of Pediatrics, College of Medicine, Chosun University, Gwangju, Korea. ryoung@chosun.ac.kr
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.
Key Words: Kernig's sign, Brudzinski's sign, Nuchal rigidity, Jolt accentuation of headache, Meningitis


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