title: Following the (Clinical Decision) Rules: Opportunities for Improving Safety and Resource Utilization With the Bacterial Meningitis Score.
abstract: BACKGROUND
  The Bacterial Meningitis Score accurately classifies children with cerebrospinal fluid (CSF) pleocytosis at very low risk (VLR) versus not very low risk (non-VLR) for bacterial meningitis. Most children with CSF pleocytosis detected during emergency department evaluation are hospitalized despite the high accuracy of this prediction rule and the decreasing incidence of bacterial meningitis. The lack of widespread use of this rule may contribute to unnecessary risk exposure and costs.
  
  
  METHODS
  This cross-sectional study included 1049 patients who, between January 2010 and May 2013, had suspicion for meningitis and underwent both a complete blood cell count and CSF studies during their emergency department evaluation. We then examined their hospitalizations to characterize exposure to drugs, radiologic studies, and the costs associated with their care to determine the safety and value repercussions of these VLR admissions. Primary outcomes include duration of antibiotics, exposure to drugs and radiology studies, safety events, and costs incurred during these VLR admissions.
  
  
  RESULTS
  Twenty patients classified as VLR were admitted to the hospital. On average they received 35 hours of antibiotic therapy. There was 1 adverse drug event and 1 safety event.
  
  
  CONCLUSIONS
  The VLR patients admitted to the hospital were exposed to risk and costs despite their low risk stratification. Systematic application of the Bacterial Meningitis Score could prevent these exposures and costs.
authors.affiliation: Division of Hospital Medicine, Cincinnati Children's Hospital and Medical Center Cincinnati, Ohio philip.hagedorn@cchmc.org.
authors.forename: Philip A
authors.initials: PA
authors.lastname: Hagedorn
authors.affiliation: Division of Hospital Medicine, Cincinnati Children's Hospital and Medical Center Cincinnati, Ohio.
authors.forename: Samir S
authors.initials: SS
authors.lastname: Shah
authors.affiliation: Division of Hospital Medicine, Cincinnati Children's Hospital and Medical Center Cincinnati, Ohio.
authors.forename: Eric S
authors.initials: ES
authors.lastname: Kirkendall
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001772:Blood Cell Count; D002648:Child; D002675:Child, Preschool; D000066491:Clinical Decision-Making; D003430:Cross-Sectional Studies; D004636:Emergency Service, Hospital / Q000191:economics / Q000706:statistics & numerical data; D005260:Female; D017722:Hospital Charges; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007964:Leukocytosis / Q000134:cerebrospinal fluid; D008297:Male; D016920:Meningitis, Bacterial / Q000175:diagnosis* / Q000188:drug therapy; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D014481:United States
chemical_list: D000900:Anti-Bacterial Agents