The diagnostic accuracy of the 'classic meningeal signs' in children with suspected bacterial meningitis

To prospectively determine the diagnostic accuracy of nuchal rigidity, Kernig's sign, and Brudzinski's sign in children with suspected bacterial meningitis. Children 3 months to 17 years old diagnosed with bacterial meningitis and matched controls without bacterial meningitis were enrolled. The diagnostic accuracy was calculated independently for each test and for a combinations of tests. Of 86 children, 40 (46.5%) had bacterial meningitis. The sensitivity, specificity, LR+, and LR- were 64.5%, 53.5%, 1.4, and 0.7 for nuchal rigidity, 52.6%, 77.5%, 2.3, and 0.6 for Brudzinski's sign, and 51.4%, 95.0%, 10.3, and 0.5 for Kernig's sign. The three tests did not yield any better results in the subsets of children with moderate or severe meningeal inflammation, nor in relation to any of the causative pathogens. In children with suspected meningitis, the three classic signs did not have a high diagnostic value and better bedside diagnostic signs are required.