Oostenbrink et al developed risk score based on clinical and laboratory findings to evaluate children with meningeal signs. This can help determine which children need a lumbar puncture and which can be spared the procedure. The authors are from the University of Utrecht in The Netherlands.
Parameters:
(1) duration of complaints in days
(2) vomiting
(3) signs of meningeal irritation
(4) cyanosis
(5) petechiae
(6) disturbed consciousness (reaction to pain only or no reaction at all)
(7) serum C-reactive protein (CRP)
|
Parameter
|
Finding
|
Points
|
|
duration of complaints in days
|
|
(number of days, as a whole number)
|
|
vomiting
|
yes
|
1
|
|
|
no
|
0
|
|
signs of meningeal irritation
|
yes
|
1
|
|
|
no
|
0
|
|
cyanosis
|
yes
|
1
|
|
|
no
|
0
|
|
petechiae
|
yes
|
1
|
|
|
no
|
0
|
|
disturbed consciousness
|
yes
|
1
|
|
|
no
|
0
|
|
serum CRP in mg/L
|
|
MIN(2, 0.1*ROUNDDOWN(CRP/10,0))
|
where:
• CRP is graded 0 points for 0-9 mg/L, 0.1 points for 10-19 mg/L etc, up to maximum 2 points (Table 3, page 615, Oostenbrink et al, 2001)
• Signs of meningeal irritation for children <= 1 year included: bulging fontanella, irritability during the examination, Brudzinki sign, Kernig sign, tripod phenomenon, or neck stiffness.
• Signs of meningeal irritation for children > 1 year included: neck pain, Brudzinki sign, Kernig sign, tripod phenomenon, or neck stiffness.
total score =
= (points for duration of complaints) + (2 * (points for vomiting)) + (7.5 * (points for meningeal irritation)) + (6.5 * (points for cyanosis)) + (4 * (points for petechiae)) + (8 * (points for disturbed consciousness)) + (points for CRP)
Interpretation:
• minimum score: 0.5
• maximum score: 31
• The risk of bacterial meningitis was considered highly unlikely if the total score is < 9.5.
• The risk of bacterial meningitis was 44% for a score >= 9.5. Those with a higher score have a higher risk.
|
Total Score
|
Rate of Bacterial Meningitis
|
|
< 9.5
|
0%
|
|
9.5 – 14.9
|
15-16%
|
|
15.0 – 19.9
|
44-63%
|
|
>= 20
|
73-98%
|
from Table 4, page 615, Oostenbrink, 2001
Performance:
• The area under the ROC curve was 0.95.
