Distinguishing between bacterial and aseptic meningitis in children: European comparison of two clinical decision rules.
BACKGROUND
Clinical decision rules (CDRs) could be helpful to safely distinguish between bacterial and aseptic meningitis (AM).


OBJECTIVE
To compare the performance of two of these CDRs for children: the Bacterial Meningitis Score (BMS) and the Meningitest.


METHODS
Secondary analysis of retrospective multicentre hospital-based cohort study.


METHODS
Six paediatric emergency or intensive care units of tertiary care centres in five European countries.


METHODS
Consecutive children aged 29 days to 18 years presenting with acute meningitis and procalcitonin (PCT) measurement. Intervention None.


METHODS
The sensitivity and specificity of the BMS (start antibiotics in case of seizure, positive cerebrospinal fluid (CSF) Gram staining, blood neutrophil count ≥10 ×10(9)/l, CSF protein level ≥80 mg/dl or CSF neutrophil count ≥1000 ×10(6)/l) and the Meningitest (start antibiotics in case of seizure, purpura, toxic appearance, PCT level ≥0.5 ng/ml, positive CSF Gram staining or CSF protein level ≥50 mg/dl) were compared using a McNemar test.


RESULTS
198 patients (mean age 4.8 years) from six centres in five European countries were included; 96 had bacterial meningitis. The BMS and Meningitest both showed 100% sensitivity (95% CI 96% to 100%). The BMS had a significantly higher specificity (52%, 95% CI 42% to 62% vs 36%, 95% CI 27% to 46%; p<10(-)8).


CONCLUSIONS
The Meningitest and the BMS were both 100% sensitive. This result provides level II evidence for the sensitivity of both rules, which can be used cautiously. However, use of the BMS could safely avoid significantly more unnecessary antibiotic treatments for children with AM than can the Meningitest in this population.
Dubos
François
F
Department of Pediatrics, Saint-Vincent-de-Paul Hospital, 74-82 avenue Denfert-Rochereau, 75014 Paris, France.
Korczowski
Bartosz
B
Aygun
Denizmen A
DA
Martinot
Alain
A
Prat
Cristina
C
Galetto-Lacour
Annick
A
Casado-Flores
Juan
J
Taskin
Erdal
E
Leclerc
Francis
F
Rodrigo
Carlos
C
Gervaix
Alain
A
Gendrel
Dominique
D
Bréart
Gérard
G
Chalumeau
Martin
M
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003657:Decision Making; D020000:Decision Support Systems, Clinical; D003937:Diagnosis, Differential; D042241:Early Diagnosis; D004636:Emergency Service, Hospital; D004812:Epidemiologic Methods; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008582:Meningitis, Aseptic / Q000175:diagnosis*; D016920:Meningitis, Bacterial / Q000175:diagnosis*