TABLE 3

Accuracy of Clinical Features

No. of PatientsSummary Sensitivity, %Summary Specificity, %Summary LR+ (95% CI)I2, %Summary LR (95% CI)I2, %
Symptom
    Bulging fontanel1728414988.0 (2.40–26.00)0.88 (0.79–0.98)
    Neck stiffness or bulging fontanelle1034120987.7 (3.20–19.00)0.82 (0.73–0.93)
    History of seizures outside febrile-convulsions age range1296532934.4 (3.00–6.40)0.73 (0.64–0.85)
    Reduced feeds12,13,17189052702.0 (1.20–3.40)920.66 (0.54–0.81)54
    Irritability1728482341.3 (1.10–1.50)0.52 (0.28–0.97)
Sign
    Petechiae10341610037 (2.00–680.00)0.94 (0.88–0.99)
    Jaundice1720596995.9 (1.80–19.00)0.95 (0.89–1.00)
    Toxic or moribund1617249925.8 (3.00–11.00)0.56 (0.42–0.73)
    Meningeal signs8,11,13,16,17a239964894.5 (2.40–8.30)940.41 (0.30–0.57)69
    Neck stiffness1113,1517311851894.0 (2.60–6.30)900.56 (0.43–0.72)87
    Bulging fontanel12,13,1517224736903.5 (2.00–6.00)840.74 (0.61–0.89)82
    Kernig sign1617253853.5 (2.10–5.70)0.56 (0.41–0.75)
    Tone up1728459823.2 (2.20–4.50)0.50 (0.36–0.70)
    Fever > 40°C9,1043319932.9 (1.60–5.50)620.81 (0.55–1.20)66
    Brudzinski sign1617266742.5 (1.80–3.60)0.46 (0.31–0.68)
    Staring eyes1364042822.4 (1.80–3.20)0.70 (0.60–0.82)
    Can't or won't feed1728461702.1 (1.50–2.80)0.56 (0.39–0.79)
    Complex seizures911b140027822.0 (1.20–3.40)840.86 (0.70–1.10)45
    Lethargic or drowsy9,1737640791.9 (1.30–2.90)480.58 (0.20–1.70)67
    Unconscious or coma811,13,1517331323861.8 (1.20–2.70)690.94 (0.85–1.10)83
    Abnormal cry1728484521.8 (1.50–2.10)0.30 (0.16–0.57)
    Restless/irritable/agitated15,1775837791.6 (1.20–2.10)00.77 (0.50–1.20)81
    Multiple seizures852264571.5 (1.10–2.10)0.62 (0.36–1.30)
    Seizures, nonspecific13,15109554631.4 (1.20–1.70)00.75 (0.48–1.20)87
    Change in mental status9,12,15,17c181572471.4 (1.20–1.70)740.54 (0.34–0.87)71
    Fever (°C not otherwise specified)151788576341.2 (0.98–1.40)620.7 (0.53–0.92)66
  • I2 is a measure of heterogeneity.

  • a Stiffness or rigidity or meningeal irritation or Brudzinski or Kernig sign.

  • b Focal or multiple or >15-minute duration or complex.

  • c Lethargic/agitated/impaired consciousness.