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28-02-2011 | General practice | Article

‘Red flag’ symptoms for meningitis revealed


Br J Gen Pract 2011; 61: 171–172

GPs should consider confusion, leg pain, photophobia, rash and neck pain or stiffness as 'red flags' for the presence of meningococcal disease in children, say researchers.

The study, published in the British Journal of General Practice, compared symptoms in 345 children with meningitis and 407 with minor febrile infections.

Of the 'classic' meningitis symptoms, photophobia and neck pain/stiffness were highly specific indicators of the disease, but headache was not helpful for distinguishing the condition from other ailments.

Leg pain, which has previously been proposed as a red flag for meningitis was highly predictive of the disease, but other possible red flags - pale colour and cold hands or feet - were not.

The team also looked at a range of other symptoms, finding that the presence of confusion was a strong indicator of meningitis, while the absence of drowsiness and the lack of a rash helped to rule it out.

Nausea or vomiting, irritability, general aching and laboured breathing were not helpful for distinguishing meningitis from other complaints.

"The findings of this study should be used as evidence to support (or modify) triage protocols used on the telephone, or face to face, by clinicians to guide assessment of children with acute infections," say Matthew Thompson (Oregon Health and Science University, Portland, USA) and co-workers.

"In a child with an acute febrile illness, confusion, leg pain, photophobia, rash and neck pain/stiffness should usually prompt a face-to-face assessment, unless another cause of these symptoms is obvious."

GP News is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2011

By Eleanor McDermid