RT Journal Article
T1 Clinical Prediction Rule for Distinguishing Bacterial From Aseptic Meningitis.
A1 Mintegi, Santiago
A1 Garcia, Silvia
A1 Martin, Maria Jose
A1 Duran, Isabel
A1 Arana-Arri, Eunate
A1 Fernandez, Catarina Livana
A1 Benito, Javier
A1 Hernandez-Bou, Susanna
K1 C-Reactive Protein
K1 Cerebrospinal Fluid Proteins
K1 Clinical Decision Rules
K1 Confidence Intervals
K1 Diagnosis, Differentia
AB New biomarkers like procalcitonin and C-reactive protein may help design an accurate decision support tool used to identify children with pleocytosis at low or high risk of bacterial meningitis. Our objective was to develop and validate a score (that we call the meningitis score for emergencies [MSE]) to distinguish bacterial meningitis from aseptic meningitis in children with pleocytosis when initially evaluated at the emergency department. We included children between 29 days and 14 years old with meningitis admitted to 25 Spanish emergency departments. A retrospective cohort from between 2011 and 2016 was used as the derivation set and a prospective cohort recruited during 2017 and 2018 was used as the validation set. Among the 1009 patients included, there were 917 cases of aseptic meningitis and 92 of bacterial meningitis. Using multivariable logistic regression analysis, we identified the following predictors of bacterial meningitis from the derivation set: procalcitonin >1.2 ng/mL, cerebrospinal fluid (CSF) protein >80 mg/dL, CSF absolute neutrophil count >1000 cells per mm3, and C-reactive protein >40 mg/L. Using the derivation set, we developed the MSE, assigning 3 points for procalcitonin, 2 points for CSF protein, and 1 point for each of the other variables. An MSE ≥1 predicted bacterial meningitis with a sensitivity of 100% (95% confidence interval [CI]: 95.0%-100%), a specificity of 83.2 (95% CI: 80.6-85.5), and a negative predictive value of 100% (95% CI 99.4-100.) CONCLUSIONS: The MSE accurately distinguishes bacterial from aseptic meningitis in children with CSF pleocytosis.
PB American Academy of Pediatrics
YR 2020
FD 2020-06-16
LK http://hdl.handle.net/10668/16154
UL http://hdl.handle.net/10668/16154
LA en
NO Mintegi S, García S, Martín MJ, Durán I, Arana-Arri E, Fernandez CL, et al. Clinical Prediction Rule for Distinguishing Bacterial From Aseptic Meningitis. Pediatrics. 2020 Sep;146(3):e20201126
DS RISalud
RD Apr 7, 2025