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.
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<10−8).
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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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.