[A diagnostic decision rule for managing children with signs of meningeal irritation].
OBJECTIVE
To develop a diagnostic decision rule based on clinical features to predict the risk of bacterial meningitis in children with signs of meningeal irritation.


METHODS
Retrospective and prospective.


METHODS
Predictors for bacterial meningitis were identified by collecting clinical data from the records of 360 patients (aged 1 month to 15 years) who consulted the Casualty Department, Sophia Children's Hospital, Rotterdam, the Netherlands, with signs of meningeal irritation during the period 1988-1998. The diagnostic decision rule derived was prospectively validated on 226 similar children who consulted the casualty departments of four hospitals in the Netherlands during the period 1999-2001.


RESULTS
Predictors for bacterial meningitis were the main complaint and vomiting (in the history) persisting for a long time, the presence of meningeal irritation, cyanosis, petechiae, disturbed consciousness (during physical examination), and a high serum concentration of C-reactive protein. Liquor analysis parameters with an added diagnostic value were the total polymorphonuclear cell count in the liquor and the liquor/blood glucose ratio. The use of these patient characteristics in a decision rule accurately predicted the chance of bacterial meningitis. The rule can also be used to refine the indication for lumbar puncture and empirical antibiotic treatment.
Oostenbrink
R
R
Erasmus Medisch Centrum, Sophia Kinderziekenhuis, afd. Algemene Kindergeneeskunde, Dr. Molewaterplein 60, 3015 GJ Rotterdam. r.oostenbrink@erasmusmc.nl
Moons
K G
KG
Derksen-Lubsen
G
G
Grobbee
D E
DE
Moll
H A
HA
D000293:Adolescent; D002097:C-Reactive Protein / Q000032:analysis; D002648:Child; D002675:Child, Preschool; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008487:Medical History Taking; D016920:Meningitis, Bacterial / Q000097:blood / Q000175:diagnosis*; D009426:Netherlands; D010808:Physical Examination; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D012189:Retrospective Studies; D012307:Risk Factors; D014839:Vomiting / Q000209:etiology
D002097:C-Reactive Protein