title: Risk scores for outcome in bacterial meningitis: Systematic review and external validation study.
abstract: To perform an external validation study of risk scores, identified through a systematic review, predicting outcome in community-acquired bacterial meningitis.
  
  
  
  MEDLINE and EMBASE were searched for articles published between January 1960 and August 2014. Performance was evaluated in 2108 episodes of adult community-acquired bacterial meningitis from two nationwide prospective cohort studies by the area under the receiver operating characteristic curve (AUC), the calibration curve, calibration slope or Hosmer-Lemeshow test, and the distribution of calculated risks.
  
  
  
  Nine risk scores were identified predicting death, neurological deficit or death, or unfavorable outcome at discharge in bacterial meningitis, pneumococcal meningitis and invasive meningococcal disease. Most studies had shortcomings in design, analyses, and reporting. Evaluation showed AUCs of 0.59 (0.57-0.61) and 0.74 (0.71-0.76) in bacterial meningitis, 0.67 (0.64-0.70) in pneumococcal meningitis, and 0.81 (0.73-0.90), 0.82 (0.74-0.91), 0.84 (0.75-0.93), 0.84 (0.76-0.93), 0.85 (0.75-0.95), and 0.90 (0.83-0.98) in meningococcal meningitis. Calibration curves showed adequate agreement between predicted and observed outcomes for four scores, but statistical tests indicated poor calibration of all risk scores.
  
  
  
  One score could be recommended for the interpretation and design of bacterial meningitis studies. None of the existing scores performed well enough to recommend routine use in individual patient management.
authors: Department of Neurology, Center of Infection and Immunity Amsterdam (CINIMA), Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors: Merijn W
authors: MW
authors: Bijlsma
authors: Department of Neurology, Center of Infection and Immunity Amsterdam (CINIMA), Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors: Matthijs C
authors: MC
authors: Brouwer
authors: Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Center of Infection and Immunity Amsterdam (CINIMA), Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors: Patrick M
authors: PM
authors: Bossuyt
authors: Department of Epidemiology and Biostatistics, VU University Medical Centre, Amsterdam, The Netherlands.
authors: Martijn W
authors: MW
authors: Heymans
authors: Department of Medical Microbiology, Center of Infection and Immunity Amsterdam (CINIMA), Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; The Netherlands Reference Laboratory for Bacterial Meningitis, Center of Infection and Immunity Amsterdam (CINIMA), Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors: Arie
authors: A
authors: van der Ende
authors: Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Center of Infection and Immunity Amsterdam (CINIMA), Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors: Michael W T
authors: MW
authors: Tanck
authors: Department of Neurology, Center of Infection and Immunity Amsterdam (CINIMA), Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. Electronic address: d.vandebeek@amc.uva.nl.
authors: Diederik
authors: D
authors: van de Beek
mesh_terms: D019540:Area Under Curve; D017714:Community-Acquired Infections / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology / Q000401:mortality; D003907:Dexamethasone / Q000627:therapeutic use; D015600:Glasgow Coma Scale; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D016920:Meningitis, Bacterial / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology / Q000401:mortality*; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment / Q000379:methods* / Q000592:standards*; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D005938:Glucocorticoids; D003907:Dexamethasone
keywords: Bacterial infections; Meningitis; Prediction rules; Prognosis; Risk stratification