title: Meningitis with a negative cerebrospinal fluid Gram stain in adults: risk classification for an adverse clinical outcome.
abstract: OBJECTIVE
  To derive and validate a risk score for an adverse clinical outcome in adults with meningitis and a negative cerebrospinal fluid (CSF) Gram stain.
  
  
  METHODS
  We conducted a retrospective study of 567 adults from Houston, Texas, with meningitis evaluated between January 1, 2005, and January 1, 2010. The patients were divided into derivation (N=292) and validation (N=275) cohorts. An adverse clinical outcome was defined as a Glasgow Outcome Scale score of 4 or less.
  
  
  RESULTS
  Of the 567 patients, 62 (11%) had an adverse clinical outcome. A predictive model was created using 3 baseline variables that were independently associated with an adverse clinical outcome (P<.05): age greater than 60 years, abnormal findings on neurologic examination (altered mental status, focal neurologic deficits, or seizures), and CSF glucose level of less than 2.4975 mmol/L (to convert CSF glucose to mmol/L, multiply by 0.05551). The model classified patients into 2 categories of risk for an adverse clinical outcome--derivation sample: low risk, 0.6% and high risk, 32.8%; P<.001; and validation sample: low risk, 0.5% and high risk, 21.1%; P<.001.
  
  
  CONCLUSIONS
  Adults with meningitis and a negative CSF Gram stain can be accurately stratified for the risk of an adverse clinical outcome using clinical variables available at presentation.
authors.affiliation: Department of Internal Medicine, University of Texas Health Science Center, Houston, TX 77030, USA.
authors.forename: Nabil T
authors.initials: NT
authors.lastname: Khoury
authors.forename: Md Monir
authors.initials: MM
authors.lastname: Hossain
authors.forename: Susan H
authors.initials: SH
authors.lastname: Wootton
authors.forename: Lucrecia
authors.initials: L
authors.lastname: Salazar
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Hasbun
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D005947:Glucose / Q000134:cerebrospinal fluid; D006801:Humans; D016015:Logistic Models; D008297:Male; D008581:Meningitis / Q000134:cerebrospinal fluid / Q000150:complications* / Q000209:etiology*; D008875:Middle Aged; D009460:Neurologic Examination; D017063:Outcome Assessment, Health Care; D012189:Retrospective Studies; D018570:Risk Assessment; D055815:Young Adult
chemical_list: D005947:Glucose