title: [Meningitis with direct negative bacteriological examination. Prospective assessment of a decision making tree].
abstract: OBJECTIVE
  Elaboration of a decision-making tree for differential diagnosis of bacterial and viral meningitis, when initial Gram's staining is negative. Method One-Year prospective study in an adult emergency department. Comparison with the immediately-preceding period.
  
  
  RESULTS
  56 patients were included. Only 4 bacterial meningitis, but none misdiagnosed. 86% sensitivity and 83% specificity for viral meningitis (n=40). Rate of patients hospitalised more than 24 hours decreasing from 62.5 to 41% (p=0.05). Antibiotic chemotherapy decreasing from 55 to 16% (p<0.001).
  
  
  CONCLUSIONS
  This decision-making tree safely allows emergency differentiation between bacterial and viral meningitis, when initial Gram's staining is negative. It consequently leads to decreased rates of useless hospitalisations and antibiotic treatments. We believe that this method can be helpful during outbreaks of viral meningitis.
authors.affiliation: Service de médecine interne B - maladies infectieuses et tropicales, Hôtel-Dieu, CHU, Nantes. david.boutoille@chu-nantes.fr
authors.forename: David
authors.initials: D
authors.lastname: Boutoille
authors.forename: Laurence
authors.initials: L
authors.lastname: Struillou
authors.forename: Dominique
authors.initials: D
authors.lastname: El Kouri
authors.forename: Philippe
authors.initials: P
authors.lastname: Le Conte
authors.forename: Marie-Dominique
authors.initials: MD
authors.lastname: Touzé
authors.forename: Gilles
authors.initials: G
authors.lastname: Potel
authors.forename: Denis
authors.initials: D
authors.lastname: Baron
authors.forename: François
authors.initials: F
authors.lastname: Raffi
mesh_terms: D000328:Adult; D000465:Algorithms; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002097:C-Reactive Protein / Q000032:analysis; D002116:Calcitonin / Q000097:blood; D016009:Chi-Square Distribution; D003627:Data Interpretation, Statistical; D003661:Decision Support Techniques; D003937:Diagnosis, Differential; D006801:Humans; D007902:Length of Stay; D016920:Meningitis, Bacterial / Q000097:blood / Q000134:cerebrospinal fluid / Q000175:diagnosis* / Q000188:drug therapy / Q000628:therapy; D008587:Meningitis, Viral / Q000097:blood / Q000134:cerebrospinal fluid / Q000175:diagnosis* / Q000188:drug therapy / Q000628:therapy; D008875:Middle Aged; D016133:Polymerase Chain Reaction; D011446:Prospective Studies; D011498:Protein Precursors / Q000097:blood; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D013997:Time Factors
chemical_list: D000900:Anti-Bacterial Agents; D011498:Protein Precursors; D002116:Calcitonin; D002097:C-Reactive Protein