Tags

Type your tag names separated by a space and hit enter

A decision rule for predicting bacterial meningitis in children with cerebrospinal fluid pleocytosis when gram stain is negative or unavailable.
Acad Emerg Med. 2008 May; 15(5):437-44.AE

Abstract

OBJECTIVES

Among children with cerebrospinal fluid (CSF) pleocytosis, the task of separating aseptic from bacterial meningitis is hampered when the CSF Gram stain result is unavailable, delayed, or negative. In this study, the authors derive and validate a clinical decision rule for use in this setting.

METHODS

This was a review of peripheral blood and CSF test results from 78 children (< 19 years) presenting to Children's Hospital Columbus from 1998 to 2002. For those with a CSF leukocyte count of > 7/microL, a rule was created for separating bacterial from viral meningitis that was based on routine laboratory tests, but excluded Gram stain. The rule was validated in 158 subjects seen at the same site (Columbus, 2002-2004) and in 871 subjects selected from a separate site (Boston, 1993-1999).

RESULTS

One point each (maximum, 6 points) was assigned for leukocytes > 597/microL, neutrophils > 74%, glucose < 38 mg/dL, and protein > 97 mg/dL in CSF and for leukocytes > 17,000/mL and bands to neutrophils > 11% in peripheral blood. Areas under receiver-operator-characteristic curves (AROCs) for the resultant score were 0.98 for the derivation set and 0.90 and 0.97, respectively, for validation sets from Columbus and Boston. Sensitivity and specificity pairs for the Boston data set were 100 and 44%, respectively, at a score of 0 and 97 and 81% at a score of 1. Likelihood ratios (LRs) increased from 0 at a score of 0 to 40 at a score of > or = 4.

CONCLUSIONS

Among children with CSF pleocytosis, a prediction score based on common tests of CSF and peripheral blood and intended for children with unavailable, negative, or delayed CSF Gram stain results has value for diagnosing bacterial meningitis.

Authors+Show Affiliations

Department of Pediatrics, Division of Emergency Medicine, Columbus Children's Hospital, Columbus, OH, USA. bonsub@pediatrics.ohio-state.eduNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

18439199

Citation

Bonsu, Bema K., et al. "A Decision Rule for Predicting Bacterial Meningitis in Children With Cerebrospinal Fluid Pleocytosis when Gram Stain Is Negative or Unavailable." Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine, vol. 15, no. 5, 2008, pp. 437-44.
Bonsu BK, Ortega HW, Marcon MJ, et al. A decision rule for predicting bacterial meningitis in children with cerebrospinal fluid pleocytosis when gram stain is negative or unavailable. Acad Emerg Med. 2008;15(5):437-44.
Bonsu, B. K., Ortega, H. W., Marcon, M. J., & Harper, M. B. (2008). A decision rule for predicting bacterial meningitis in children with cerebrospinal fluid pleocytosis when gram stain is negative or unavailable. Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine, 15(5), 437-44. https://doi.org/10.1111/j.1553-2712.2008.00099.x
Bonsu BK, et al. A Decision Rule for Predicting Bacterial Meningitis in Children With Cerebrospinal Fluid Pleocytosis when Gram Stain Is Negative or Unavailable. Acad Emerg Med. 2008;15(5):437-44. PubMed PMID: 18439199.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A decision rule for predicting bacterial meningitis in children with cerebrospinal fluid pleocytosis when gram stain is negative or unavailable. AU - Bonsu,Bema K, AU - Ortega,Henry W, AU - Marcon,Mario J, AU - Harper,Marvin B, PY - 2008/4/29/pubmed PY - 2008/5/23/medline PY - 2008/4/29/entrez SP - 437 EP - 44 JF - Academic emergency medicine : official journal of the Society for Academic Emergency Medicine JO - Acad Emerg Med VL - 15 IS - 5 N2 - OBJECTIVES: Among children with cerebrospinal fluid (CSF) pleocytosis, the task of separating aseptic from bacterial meningitis is hampered when the CSF Gram stain result is unavailable, delayed, or negative. In this study, the authors derive and validate a clinical decision rule for use in this setting. METHODS: This was a review of peripheral blood and CSF test results from 78 children (< 19 years) presenting to Children's Hospital Columbus from 1998 to 2002. For those with a CSF leukocyte count of > 7/microL, a rule was created for separating bacterial from viral meningitis that was based on routine laboratory tests, but excluded Gram stain. The rule was validated in 158 subjects seen at the same site (Columbus, 2002-2004) and in 871 subjects selected from a separate site (Boston, 1993-1999). RESULTS: One point each (maximum, 6 points) was assigned for leukocytes > 597/microL, neutrophils > 74%, glucose < 38 mg/dL, and protein > 97 mg/dL in CSF and for leukocytes > 17,000/mL and bands to neutrophils > 11% in peripheral blood. Areas under receiver-operator-characteristic curves (AROCs) for the resultant score were 0.98 for the derivation set and 0.90 and 0.97, respectively, for validation sets from Columbus and Boston. Sensitivity and specificity pairs for the Boston data set were 100 and 44%, respectively, at a score of 0 and 97 and 81% at a score of 1. Likelihood ratios (LRs) increased from 0 at a score of 0 to 40 at a score of > or = 4. CONCLUSIONS: Among children with CSF pleocytosis, a prediction score based on common tests of CSF and peripheral blood and intended for children with unavailable, negative, or delayed CSF Gram stain results has value for diagnosing bacterial meningitis. SN - 1553-2712 UR - https://www.unboundmedicine.com/medline/citation/18439199/A_decision_rule_for_predicting_bacterial_meningitis_in_children_with_cerebrospinal_fluid_pleocytosis_when_gram_stain_is_negative_or_unavailable_ L2 - https://doi.org/10.1111/j.1553-2712.2008.00099.x DB - PRIME DP - Unbound Medicine ER -