Clinical Prediction Rule for Distinguishing Bacterial From Aseptic Meningitis.

New biomarkers like procalcitonin and C-reactive protein may help design an accurate decision support tool used to identify children with pleocytosis at low or high risk of bacterial meningitis. Our objective was to develop and validate a score (that we call the meningitis score for emergencies [MSE]) to distinguish bacterial meningitis from aseptic meningitis in children with pleocytosis when initially evaluated at the emergency department. We included children between 29 days and 14 years old with meningitis admitted to 25 Spanish emergency departments. A retrospective cohort from between 2011 and 2016 was used as the derivation set and a prospective cohort recruited during 2017 and 2018 was used as the validation set. Among the 1009 patients included, there were 917 cases of aseptic meningitis and 92 of bacterial meningitis. Using multivariable logistic regression analysis, we identified the following predictors of bacterial meningitis from the derivation set: procalcitonin >1.2 ng/mL, cerebrospinal fluid (CSF) protein >80 mg/dL, CSF absolute neutrophil count >1000 cells per mm3, and C-reactive protein >40 mg/L. Using the derivation set, we developed the MSE, assigning 3 points for procalcitonin, 2 points for CSF protein, and 1 point for each of the other variables. An MSE ≥1 predicted bacterial meningitis with a sensitivity of 100% (95% confidence interval [CI]: 95.0%-100%), a specificity of 83.2 (95% CI: 80.6-85.5), and a negative predictive value of 100% (95% CI 99.4-100.) CONCLUSIONS: The MSE accurately distinguishes bacterial from aseptic meningitis in children with CSF pleocytosis.

Mintegi S ，García S ，Martín MJ ，Durán I ，Arana-Arri E ，Fernandez CL ，Benito J ，Hernández-Bou S ，Meningitis Group of the Spanish Society of Pediatric Emergencies ... -  《-》

Development and validation of a multivariable predictive model to distinguish bacterial from aseptic meningitis in children in the post-Haemophilus influenzae era.

Nigrovic LE ，Kuppermann N ，Malley R 《-》

Serum procalcitonin and other biologic markers to distinguish between bacterial and aseptic meningitis.

Dubos F ，Moulin F ，Gajdos V ，De Suremain N ，Biscardi S ，Lebon P ，Raymond J ，Breart G ，Gendrel D ，Chalumeau M ... -  《JOURNAL OF PEDIATRICS》

Serum procalcitonin level and other biological markers to distinguish between bacterial and aseptic meningitis in children: a European multicenter case cohort study.

Dubos F ，Korczowski B ，Aygun DA ，Martinot A ，Prat C ，Galetto-Lacour A ，Casado-Flores J ，Taskin E ，Leclerc F ，Rodrigo C ，Gervaix A ，Leroy S ，Gendrel D ，Bréart G ，Chalumeau M ... -  《-》

Diagnostic value of immature neutrophils (bands) in the cerebrospinal fluid of children with cerebrospinal fluid pleocytosis.

Kanegaye JT ，Nigrovic LE ，Malley R ，Cannavino CR ，Schwab SH ，Bennett JE ，Mohseni MM ，Wang VJ ，Katsogridakis YL ，Herman MI ，Kuppermann N ，American Academy of Pediatrics, Pediatric Emergency Medicine Collaborative Research Committee ... -  《-》