PT - JOURNAL ARTICLE AU - Alexander Tracy AU - Thomas Waterfield TI - How to use clinical signs of meningitis AID - 10.1136/archdischild-2018-315428 DP - 2020 Feb 01 TA - Archives of disease in childhood - Education & practice edition PG - 46--49 VI - 105 IP - 1 4099 - http://ep.bmj.com/content/105/1/46.short 4100 - http://ep.bmj.com/content/105/1/46.full SO - Arch Dis Child Educ Pract Ed2020 Feb 01; 105 AB - Meningitis is a critical diagnosis not to miss in children presenting with fever. Since the early 20th century, classical clinical signs have been used to aid the diagnosis of meningitis. These classical signs are nuchal rigidity, Kernig’s sign and Brudzinski’s sign. Each of these relies on the principle that stretching the inflamed meningeal membranes causes clinically detectable irritation. Several primary studies have quantified the diagnostic performance of clinical examination in detecting meningitis in children. The results of these studies vary significantly due to methodological differences, clinical heterogeneity and interobserver variability. However, their findings demonstrate that positive meningitic signs increase the likelihood of a diagnosis of meningitis, and the absence of meningitic signs reduces this probability. These signs have greatest utility when combined with other features in the history and examination to contribute to a comprehensive clinical assessment.