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Table 3 Comparison of potential screening criteria at admission for definite meningitis (excluding children with possible meningitis only (Group C, n=51))

From: Clinical features of bacterial meningitis among hospitalised children in Kenya

Screening criteria No. with criteria No. with meningitis Sensitivity % (95% CI) Specificity % (95%CI) PPV % (95% CI) NPV % (95% CI) NNLP (955% CI)
Bulging fontanela or neck stiffness 161 23 23.5 (15.5–33.1) 98.9 (98.7–99.1) 14.3 (9.3–20.7) 99.4 (99.3–99.5) 7 (5–12)
Cyanosis or any of the above 207 23 23.5 (15.5–33.1) 98.6 (98.3–98.8) 11.1 (7.2–16.2) 99.4 (99.3–99.5) 10 (7–16)
Seizures outside 6 months to 6 years or any of the above 771 33 33.7 (24.4–43.9) 94.3 (93.8–94.6) 4.3 (3.0–6.0) 99.5 (99.3–99.6) 27 (19–43)
Focal seizures or any of the above 1023 39 39.8 (30.0–50.2) 92.3 (91.9–92.8) 3.8 (2.7–5.2) 99.5 (99.4–99.6) 30 (22–47)
Impaired consciousness or any of the above 2659 57 58.2 (47.8–68.1) 79.7 (79.0–80.4) 2.1 (1.6–2.8) 99.6 (99.5–99.7) 57 (43–85)
Fever without malaria parasitemia or any of the above 8099 84 85.7 (77.2–92.0) 37.6 (36.7–38.4) 1.0 (0.8–1.3) 99.7 (99.5–99.8) 134 (99–208)
IMCI referral criteria: neck stiffness, lethargy, impaired consciousness, or seizures 4951 78 79.6 (70.3–87.1) 62.0 (61.2–62.9) 1.6 (1.3–2.0) 99.7 (99.6–99.8) 76 (59–104)
  1. Abbreviations: CI confidence interval, PPV positive predictive values, NPV negative predictive value, NNLP number needed to lumbar puncture, IMCI integrated management of childhood infection
  2. ‘Or any of the above’ refers to the presence of ≥1 of the signs indicated in the preceding rows. This means that children represented on each row had the sign indicated on a particular row +/- any of the preceding signs. For example, 161 children had either bulging fontanel or neck stiffness (13 had both). 1023 children had ≥1 focal seizures, seizures outside the febrile convulsion age range, cyanosis, bulging fontanel, or neck stiffness (252 had focal seizures only while 771 had focal seizures and ≥1 of seizures outside the febrile convulsion age range, cyanosis, bulging fontanel, and neck stiffness [e.g. 76 had focal seizures which occurred outside the febrile convulsion age range; 1 had focal seizures which occurred outside the febrile convulsion age range and cyanosis])
  3. aBulging fontanel was only deemed present if the age was ≤18 months