title: Trends in the management of viral meningitis at United States children's hospitals.
abstract: OBJECTIVE
  To determine trends in the diagnosis and management of children with viral meningitis at US children's hospitals.
  
  
  METHODS
  We performed a multicenter cross sectional study of children presenting to the emergency department (ED) across the 41 pediatric tertiary-care hospitals participating in the Pediatric Health Information System between January 1, 2005, and December 31, 2011. A case of viral meningitis was defined by International Classification of Diseases, Ninth Revision, discharge diagnosis, and required performance of a lumbar puncture. We examined trends in diagnosis, antibiotic use, and resource utilization for children with viral meningitis over the study period.
  
  
  RESULTS
  We identified 7618 children with viral meningitis (0.05% of ED visits during the study period). Fifty-two percent of patients were <1 year of age, and 43% were female. The absolute number and the proportion of ED visits for children with viral meningitis declined from 0.98 cases per 1000 ED visits in 2005 to 0.25 cases in 2011 (P < .001). Most children with viral meningitis received a parenteral antibiotic (85%), and were hospitalized (91%). Overall costs for children for children with viral meningitis remain substantial (median cost per case $5056, interquartile range $3572-$7141).
  
  
  CONCLUSIONS
  Between 2005 and 2011, viral meningitis diagnoses at US children's hospitals declined. However, most of these children are hospitalized, and the cost for caring for these children remains considerable.
authors.affiliation: Division of Emergency Medicine, Department of Medicine, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts 02115, USA. lise.nigrovic@childrens.harvard.edu
authors.forename: Lise E
authors.initials: LE
authors.lastname: Nigrovic
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Fine
authors.forename: Michael C
authors.initials: MC
authors.lastname: Monuteaux
authors.forename: Samir S
authors.initials: SS
authors.lastname: Shah
authors.forename: Mark I
authors.initials: MI
authors.lastname: Neuman
mesh_terms: D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000191:economics / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D016208:Databases, Factual; D004636:Emergency Service, Hospital / Q000191:economics / Q000706:statistics & numerical data / Q000639:trends*; D005260:Female; D006295:Health Resources / Q000191:economics / Q000706:statistics & numerical data; D017721:Hospital Costs / Q000706:statistics & numerical data / Q000639:trends; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data / Q000639:trends; D006776:Hospitals, Pediatric / Q000191:economics / Q000706:statistics & numerical data / Q000639:trends*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008587:Meningitis, Viral / Q000175:diagnosis / Q000191:economics / Q000453:epidemiology / Q000628:therapy; D016012:Poisson Distribution; D010818:Practice Patterns, Physicians' / Q000191:economics / Q000706:statistics & numerical data / Q000639:trends*; D062606:Tertiary Care Centers / Q000191:economics / Q000706:statistics & numerical data / Q000639:trends*; D014481:United States / Q000453:epidemiology
chemical_list: D000900:Anti-Bacterial Agents