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BET 4: Are meningeal irritation signs reliable in diagnosing meningitis in children?

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Report by: Dr Mark Ross, A&E Consultant

Search checked by: Dr Hisham Ghanayem, SET Manchester Royal Infirmary

Institution: Royal Prince Alfred Hospital, Sydney, Australia

Three-part question

In (children), are (meningeal irritation signs, specifically Kernig's sign, Brudzinski's sign or neck stiffness), reliable signs in helping to (diagnose bacterial meningitis)?

Clinical scenario

A 3-year-old girl is brought to the emergency department by her parents. She has vomited multiple times and has been feverish and lethargic over the last 24 h. On examination, she is feverish, she has a stiff neck and Kernig's sign is positive. You are concerned about the possibility of meningitis but …

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