New ‘red flags’ for meningitis

New ‘red flags’ for meningitis

02 March 2010

LEG pain and cold hands and feet have emerged as leading ‘red flag’ symptoms in diagnosing children presenting with meningococcal disease in a new study.

Primary care researchers at the University of Oxford found that both signs are highly predictive of meningococcal disease in children and adolescents. The symptoms can help GPs distinguish children with meningitis from minor febrile illness. The results of the large study into UK general practice will be presented at the Society for Academic Primary Care annual meeting later this month.

Children with leg pain were seven times more like to have meningococcal disease – and children with cold hands and feet were twice as likely – compared to children with minor feverish illness, the study found.

Researchers compared the symptoms of 924 children who presented to 15 practices in Oxfordshire and Somerset with feverish illnesses with the symptom frequencies recorded from 345 children with meningococcal disease.

Leg pain, cold hand or feet, confusion, photophobia and neck pain or stiffness were all rarely reported by the parents of children with minor febrile illness. All these symptoms were found to be “highly specific for meningococcal disease” but pallor and headache had little diagnostic value.

Dr Tanya Haj-Hassan, a researcher in childhood infections at the University of Oxford, concluded: “The early red flag features of leg pain and cold extremities, as well as classical features of photophobia and neck pain and stiffness, are all highly specific for meningococcal disease.

“Confusion also emerged as an important red flag in children with meningococcal disease, and was as sensitive and specific as classic and red flag features. When these symptoms are reported by parents they should usually prompt an urgent face-to-face assessment with a clinician to exclude meningococcal disease.”

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