title: Distinguishing between bacterial and aseptic meningitis in children: European comparison of two clinical decision rules.
abstract: 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.
authors.affiliation: Department of Pediatrics, Saint-Vincent-de-Paul Hospital, 74-82 avenue Denfert-Rochereau, 75014 Paris, France.
authors.forename: François
authors.initials: F
authors.lastname: Dubos
authors.forename: Bartosz
authors.initials: B
authors.lastname: Korczowski
authors.forename: Denizmen A
authors.initials: DA
authors.lastname: Aygun
authors.forename: Alain
authors.initials: A
authors.lastname: Martinot
authors.forename: Cristina
authors.initials: C
authors.lastname: Prat
authors.forename: Annick
authors.initials: A
authors.lastname: Galetto-Lacour
authors.forename: Juan
authors.initials: J
authors.lastname: Casado-Flores
authors.forename: Erdal
authors.initials: E
authors.lastname: Taskin
authors.forename: Francis
authors.initials: F
authors.lastname: Leclerc
authors.forename: Carlos
authors.initials: C
authors.lastname: Rodrigo
authors.forename: Alain
authors.initials: A
authors.lastname: Gervaix
authors.forename: Dominique
authors.initials: D
authors.lastname: Gendrel
authors.forename: Gérard
authors.initials: G
authors.lastname: Bréart
authors.forename: Martin
authors.initials: M
authors.lastname: Chalumeau
mesh_terms: 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*