Epidemiology of Lumbar Puncture and the Validity of Meningeal Signs in Predicting Meningitis in Children: A Cross-sectional Study

Introduction: Predictive models have been developed to estimate the likelihood of bacterial meningitis in patients with clinical features suggestive of Central Nervous System (CNS) involvement. Early diagnosis and prompt treatment of bacterial meningitis in children are crucial due to the severity and rapid progression of the disease. However, making a definitive diagnosis in the early stages can be challenging, as clinical symptoms are often non specific and may overlap with other conditions. Lumbar Puncture (LP) is a crucial diagnostic and therapeutic procedure in paediatric medicine to diagnose various neurological diseases, particularly meningitis, by analysing Cerebrospinal Fluid (CSF). Aim: To analyse the epidemiological trends of LP performed in children and to evaluate the accuracy of meningeal signs in predicting the presence of meningitis in paediatric patients. Materials and Methods: This was a cross-sectional study conducted in the Department of Paediatrics at Amala Institute of Medical Sciences, Thrissur, Kerala, South India, from August 2018 to July 2019. The records of paediatric patients (aged 1 month to 12 years) who underwent LP during the one year from August 2018 to July 2019 at the centre were collected. A checklist was prepared for all the patients, where demographic data, clinical presentations, findings of CSF, and blood analysis were recorded. The data obtained were analysed using Statistical Package for Social Sciences (SPSS) version 23.0. Results: Out of 3,125 paediatric admissions during the study period, LP was performed in 125 (4%). The most common indication for LP was fever with seizure in 53 (42.4%), followed by fever and vomiting in 44 (35.2%). There was a statistically significant association between both CSF protein and CSF sugar and a diagnosis of meningitis. Among children presenting with fever and seizure in the age group of one month to two years, 19 (52.8%) had meningitis. The incidence of pyogenic meningitis was 26 (20.8%). Organisms were isolated in 2 (1.6%) of cases. Among the meningeal signs, the Johny Vincent sign and neck stiffness showed better sensitivity, while Kernig’s sign was the most specific. Conclusion: The present study concludes that, in paediatrics, LP remains an essential procedure for differentiating patients with meningitis from those without meningitis when they present with the same symptoms, especially in children less than two years of age. In older children, clinical variables such as meningeal signs and seizures at admission had lower sensitivity and Positive Predictive Value (PPV), which again highlights the need for performing an LP.