Clinical Prediction Rule for Distinguishing Bacterial From Aseptic Meningitis. Mintegi, S.; García, S.; Martín, M. J.; Durán, I.; Arana-Arri, E.; Fernandez, C. L.; Benito, J.; Hernández-Bou, S.; and Emergencies, M. G. o. t. S. S. o. P. Pediatrics, August, 2020. Publisher: American Academy of Pediatrics Section: Article
Clinical Prediction Rule for Distinguishing Bacterial From Aseptic Meningitis [link]Paper  doi  abstract   bibtex   
Video Player is loading.Play VideoPlayMuteCurrent Time 0:00/Duration 4:09Loaded: 4.00%0:00Stream Type LIVESeek to live, currently behind liveLIVERemaining Time -4:09 Share1xPlayback RateChaptersChaptersDescriptionsdescriptions off, selectedCaptionscaptions settings, opens captions settings dialogcaptions off, selectedAudio Tracken (Main), selectedPicture-in-PictureFullscreenThis is a modal window.Beginning of dialog window. Escape will cancel and close the window.TextColorWhiteBlackRedGreenBlueYellowMagentaCyanTransparencyOpaqueSemi-TransparentBackgroundColorBlackWhiteRedGreenBlueYellowMagentaCyanTransparencyOpaqueSemi-TransparentTransparentWindowColorBlackWhiteRedGreenBlueYellowMagentaCyanTransparencyTransparentSemi-TransparentOpaqueFont Size50%75%100%125%150%175%200%300%400%Text Edge StyleNoneRaisedDepressedUniformDropshadowFont FamilyProportional Sans-SerifMonospace Sans-SerifProportional SerifMonospace SerifCasualScriptSmall CapsReset restore all settings to the default valuesDoneClose Modal DialogEnd of dialog window.Close Modal DialogThis is a modal window. This modal can be closed by pressing the Escape key or activating the close button.Close Modal DialogThis is a modal window. This modal can be closed by pressing the Escape key or activating the close button.Video Abstract BACKGROUND: 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. METHODS: 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. RESULTS: 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 \textgreater1.2 ng/mL, cerebrospinal fluid (CSF) protein \textgreater80 mg/dL, CSF absolute neutrophil count \textgreater1000 cells per mm3, and C-reactive protein \textgreater40 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.
@article{mintegi_clinical_2020,
	title = {Clinical {Prediction} {Rule} for {Distinguishing} {Bacterial} {From} {Aseptic} {Meningitis}},
	copyright = {Copyright © 2020 by the American Academy of Pediatrics},
	issn = {0031-4005, 1098-4275},
	url = {https://pediatrics.aappublications.org/content/early/2020/08/25/peds.2020-1126},
	doi = {10.1542/peds.2020-1126},
	abstract = {Video Player is loading.Play VideoPlayMuteCurrent Time 0:00/Duration 4:09Loaded: 4.00\%0:00Stream Type LIVESeek to live, currently behind liveLIVERemaining Time -4:09 Share1xPlayback RateChaptersChaptersDescriptionsdescriptions off, selectedCaptionscaptions settings, opens captions settings dialogcaptions off, selectedAudio Tracken (Main), selectedPicture-in-PictureFullscreenThis is a modal window.Beginning of dialog window. Escape will cancel and close the window.TextColorWhiteBlackRedGreenBlueYellowMagentaCyanTransparencyOpaqueSemi-TransparentBackgroundColorBlackWhiteRedGreenBlueYellowMagentaCyanTransparencyOpaqueSemi-TransparentTransparentWindowColorBlackWhiteRedGreenBlueYellowMagentaCyanTransparencyTransparentSemi-TransparentOpaqueFont Size50\%75\%100\%125\%150\%175\%200\%300\%400\%Text Edge StyleNoneRaisedDepressedUniformDropshadowFont FamilyProportional Sans-SerifMonospace Sans-SerifProportional SerifMonospace SerifCasualScriptSmall CapsReset restore all settings to the default valuesDoneClose Modal DialogEnd of dialog window.Close Modal DialogThis is a modal window. This modal can be closed by pressing the Escape key or activating the close button.Close Modal DialogThis is a modal window. This modal can be closed by pressing the Escape key or activating the close button.Video Abstract
BACKGROUND: 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.
METHODS: 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.
RESULTS: 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 {\textgreater}1.2 ng/mL, cerebrospinal fluid (CSF) protein {\textgreater}80 mg/dL, CSF absolute neutrophil count {\textgreater}1000 cells per mm3, and C-reactive protein {\textgreater}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.},
	language = {en},
	urldate = {2020-08-31},
	journal = {Pediatrics},
	author = {Mintegi, Santiago and García, Silvia and Martín, María José and Durán, Isabel and Arana-Arri, Eunate and Fernandez, Catarina Livana and Benito, Javier and Hernández-Bou, Susanna and Emergencies, Meningitis Group of the Spanish Society of Pediatric},
	month = aug,
	year = {2020},
	pmid = {32843440},
	note = {Publisher: American Academy of Pediatrics
Section: Article},
	keywords = {Article, Pediatria, Urgències},
}
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