Nigrovic et al developed a Bacterial Meningitis Score (BMS) to distinguish bacterial from aseptic meningitis in children. The authors are from Boston Children's Hospital, Harvard University and the University of California in Davis.
Patient selection: 29 days to 19 years old
Parameters:
(1) Gram stain of CSF
(2) CSF protein in mg/dL
(3) absolute neutrophil count in the peripheral blood
(4) absolute neutrophil count in the CSF
(5) seizures before or at presentation to the hospital
Parameter
Finding
Points
Gram stain of CSF
negative
0
positive for bacteria
2
CSF protein
< 80 mg/dL
0
>= 80 mg/dL
1
absolute neutrophil count in blood
< 10,000 per µL
0
>= 10,000 per µL
1
absolute neutrophil count in CSF
< 1,000 per µL
0
>= 1,000 per µL
1
seizures
absent
0
present
1
total score =
= SUM(points for all 5 parameters)
Interpretation:
• minimum score: 0
• maximum score: 6
• The higher the score the more likely the patient has a bacterial meningitis.
Total Score
Percent with Aseptic Meningitis
Percent with Bacterial Meningitis
0
100%
0%
1
90%
10%
2
13%
87%
Performance (page 716):
• A score >= 2 was 87% sensitive and 73% specific for bacterial meningitis.
• All patients with a score of 0 had aseptic meningitis.
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