Objectives Defining clinical and cerebrospinal fluid (CSF) criteria that establish a diagnosis of sepsis and meningitis immediately on admission.

Methods One thousand children, aged one day to 13 years, presenting with acute onset of vomiting, fever, convulsion, and diarrhoea to the Paediatrics Department, King Abdul-Aziz University Hospital, Jeddah, Saudi Arabia from January 1997 to December 2000 were evaluated. Cases were subjected to history, clinical examination and lumbar puncture. On admission, chemical, cytological and bacteriological examinations of blood and CSF were carried out. Patients were divided into sepsis (n  =  94) and meningitis (n  =  26) groups.

Results The most common age of liability for lumbar puncture was in the neonatal period (35.8%), which also exhibited sepsis and meningitis frequency. Septic cases were 78.3% compared with 21.7% for meningitis. The predominant symptom in all groups was vomiting. In meningitis, haemoglobin was less (p<0.05), whereas white blood cell counts (WBC) (p<0.05), blood neutrophils (p<0.05), CSF chloride (p<0.000) and CSF WBC (p<0.001) were more than sepsis. A positive correlation was found between CSF glucose with WBC (r  =  0.52, p<0.05), neutrophils (r  =  0.49, p<0.05) and blood glucose (r  =  0.56, p<0.01) and between CSF WBC and CSF protein (r  =  0.55, p<0.01). In sepsis, a positive correlation was found between CSF lymphocyte and CSF red blood cell count (r  =  0.37, p<0).

Conclusion Septic cases admitted to the paediatric department as a result of emergency exceeded meningitis cases. Neonates were the most common patients for lumbar puncture, with vomiting a prevalent presenting symptom. Children exhibiting vomiting, convulsions and no organism in the CSF must be carefully examined in hospital with urine and blood cultures re-evaluated by a paediatrician.