Validation of a clinical prediction rule to distinguish bacterial from aseptic meningitis

  • G. A
  • M. D
  • P. G
 et al. 
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Abstract

Introduction: Despite most meningitis are not bacterial, because it is difficult to rule-out bacterial meningitis, antibiotics are usually administered on admission. To distinguish bacterial from aseptic meningitis on admission could avoid inappropriate antibiotic use and hospitalization. We aimed to validate the clinical prediction rule to distinguish bacterial from aseptic meningitis developed by Nigrovic (2002). Methods: This prospective study included patients aged one monthto nineteen years with meningitis, admitted to Elizalde Hospital between September 2006 and October 2007. Cerebrospinal fluid (CSF) and peripheral blood neutrophil count were obtained from all patients. The Nigrovic clinical prediction rule was calculated according to the following criteria: positive CSF Gram stain = 2 points, CSF absolute neutrophil count ' 1000 cells/mm = 1 point, CSF protein ' 80 mg/dl = 1 point, peripheral blood absolute neutrophil count ' 10.000/mm3 = 1 point, seizure = 1 point. Patients with score = 0 were classified as very low risk of bacterial meningitis and those with score ' 2 were classified at high risk. Sensitivity (S), specificity (E), predictive values (PPV and NPV), likelihood ratios (PLR and NLR) were calculated with 95% confidence intervals. Informed consent from all participants was obtained. Results: 70 patients with meningitis were included, 14 of these were bacterial meningitis. When Nigrovic score was calculated, 25 patients presented score = 0 points, 11 score = 1 point, and 34 score > 2 points. A score = 0 showed S: 100%, E: 44%, VPP: 31%, VPN: 100%,RVP: 1,81% RVN: 0 %. A score > predicted bacterial meningitis with S: 100%, E: 64%, VPP: 41%, VPN: 100 %, PLR: 2.8, NLR: 0. Discussion: Using Nigrovic score was simple, and allowed identifying children with very low risk of bacterial meningitis. It could be a useful tool to assist clinical decision making.

Author-supplied keywords

  • *aseptic meningitis
  • *prediction
  • *society
  • Gram staining
  • aged
  • antibiotic agent
  • bacterial meningitis
  • blood
  • cerebrospinal fluid
  • child
  • clinical decision making
  • confidence interval
  • hospital
  • hospitalization
  • informed consent
  • meningitis
  • n [n (3 carboxyoxirane 2 carbonyl)leucyl]agmatine
  • neutrophil count
  • patient
  • prospective study
  • protein cerebrospinal fluid level
  • risk
  • seizure

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Authors

  • Aguero G.

  • Del Valle M.

  • Gallegos P.

  • Kannemann A.

  • Bokser V.

  • Ferrero F.

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