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Distinguishing between bacterial and aseptic meningitis in children: European comparison of two clinical decision rules
  1. François Dubos1,2,3,
  2. Bartosz Korczowski4,
  3. Denizmen A Aygun5,
  4. Alain Martinot2,
  5. Cristina Prat6,
  6. Annick Galetto-Lacour7,
  7. Juan Casado-Flores8,
  8. Erdal Taskin5,
  9. Francis Leclerc9,
  10. Carlos Rodrigo10,
  11. Alain Gervaix7,
  12. Dominique Gendrel1,
  13. Gérard Bréart3,
  14. Martin Chalumeau1,3
  1. 1Department of Pediatrics, Saint-Vincent-de-Paul Hospital, AP-HP, Paris Descartes University, Paris, France
  2. 2Department of Pediatric Emergencies and Infectious Diseases, Roger-Salengro Hospital, Lille Nord-de-France University, Lille, France
  3. 3INSERM U953, Saint-Vincent-de-Paul Hospital, Paris, France
  4. 4Department of Pediatrics, Regional Hospital no 2, University of Rzeszów, Poland
  5. 5Department of Pediatrics, Firat University, Elazig, Turkey
  6. 6Department of Microbiology, Hospital Universitari Germans Trias i Pujol, Universidad Autonoma de Barcelona, Badalona, Spain
  7. 7Child and Adolescent Department, University Hospital, Geneva, Switzerland
  8. 8Pediatric Intensive Care Unit, Hospital Universitario del Nino Jesus, Universidad Autonoma de Madrid, Madrid, Spain
  9. 9Pediatric Intensive Care Unit, Jeanne-de-Flandre Hospital, CHU Lille, Lille Nord-de-France University, Lille, France
  10. 10Department of Pediatrics and Pediatric Infectious Disease Unit, Hospital Universitari Germans Trias i Pujol, Universidad Autonoma de Barcelona, Badalona, Spain
  1. Correspondence to Professor Martin Chalumeau, Department of Pediatrics, Saint-Vincent-de-Paul Hospital, 74–82 avenue Denfert-Rochereau, 75014 Paris, France; martin.chalumeau{at}svp.aphp.fr

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.

Design Secondary analysis of retrospective multicentre hospital-based cohort study.

Setting Six paediatric emergency or intensive care units of tertiary care centres in five European countries.

Patients Consecutive children aged 29 days to 18 years presenting with acute meningitis and procalcitonin (PCT) measurement.

Intervention None.

Main outcome measures The sensitivity and specificity of the BMS (start antibiotics in case of seizure, positive cerebrospinal fluid (CSF) Gram staining, blood neutrophil count ≥10 ×109/l, CSF protein level ≥80 mg/dl or CSF neutrophil count ≥1000 ×106/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<108).

Conclusion 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.

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Footnotes

  • Presented at the European Society for Pediatric Infectious Diseases annual meeting, Porto, Portugal, May 2007.

  • Funding This study was supported by the Direction de la Recherche Clinique and the Unit of Clinical Research in Hospital Cochin–Saint-Vincent-de-Paul, grant CRC 03154 from the Assistance Publique–Hôpitaux de Paris, the Fond d'Etude et de Recherche du Corps Médical des Hôpitaux de Paris and the Fondation Bayer Santé.

  • Competing interests MC and DG have received unconditional research support (less than €30 000) from Brahms AG, which manufactures PCT, for other studies on other topics in 2005 and 2007. FD and MC had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

  • Ethics approval This study was conducted with the approval obtained from each institution.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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