[Utility of Boyer's score modified for the differential diagnosis of bacterial and viral meningitis].
BACKGROUND
Many studies have been performed to establish criteria for the differential diagnosis between bacterial and viral meningitis. In 1980, Thome and Boyer proposed a score that has been widely used.


OBJECTIVE
The aim of this study was to assess the utility of this score when applied to our patients with meningitis and to evaluate the diagnostic yield after adding other laboratory tests.


METHODS
We retrospectively studied the children diagnosed with meningitis in the Hospital Niño Jesús between January 1993 and February 2000. In all patients, Boyer's score and the following laboratory variables were applied: reactive C protein levels, percentage of neutrophils in the cerebrospinal fluid depending on age, and the ratio of immature cells/total neutrophils in the blood. We calculated the sensitivity and specificity of Boyer's score and the laboratory variables.


RESULTS
Of the 476 children with meningitis, 402 had viral meningitis and 74 had bacterial meningitis. All the children with bacterial meningitis except seven had a score higher than 3 (a doubtful indication for antibiotic treatment). The sensitivity and specificity of Boyer's score was 90 % and 99 % respectively. When laboratory variables were added, sensitivity was 100 % and specificity was 98 %.


CONCLUSIONS
Boyer's score is a useful tool for the differential diagnosis of meningitis, but its diagnostic yield is considerably increased when the results of laboratory tests are added.
Pérez Martínez
A
A
Servicio de Urgencias. Hospital del Niño Jesús. Madrid. antonio121@navegalia.com
Molina Cabañero
J C
JC
Quintero Calcaño
V
V
de Vicente Aymat
A
A
de La Torre Espí
M
M
D002648:Child; D019411:Clinical Laboratory Techniques; D003937:Diagnosis, Differential; D006801:Humans; D016920:Meningitis, Bacterial / Q000175:diagnosis*; D008587:Meningitis, Viral / Q000175:diagnosis*; D012189:Retrospective Studies; D012680:Sensitivity and Specificity