The Boyer Score can be used to differentiate between bacterial and viral meningitis, particularly in children.
Patient selection: meningitis
Parameters:
(1) body temperature in °C
(2) purpura
(3) neurologic findings (altered mental status, coma, seizures without focal signs)
(4) white blood cell count per microliter
(5) CSF leukocyte count per microliter
(6) percent neutrophils in the CSF
(7) CSF protein in mg/dL
(8) CSF glucose in mg/dL
|
Parameter |
Finding |
Points |
|
body temperature |
< 39.5°C |
0 |
|
|
>= 39.5°C |
1 |
|
purpura |
absent |
0 |
|
|
present |
2 |
|
neurologic findings |
absent |
0 |
|
|
present |
1 |
|
WBC count |
< 15,000 |
0 |
|
|
>= 15,000 |
1 |
|
CSF leukocyte count |
< 1,000 |
0 |
|
|
1,000 to 4,000 |
1 |
|
|
> 4,000 |
2 |
|
percent neutrophils CSF |
< 60% |
0 |
|
|
>= 60% |
1 |
|
CSF protein |
< 90 |
0 |
|
|
90 to 140 |
1 |
|
|
> 140 |
2 |
|
CSF glucose |
> 35 |
0 |
|
|
20 to 35 |
1 |
|
|
< 20 |
2 |
total score =
= SUM(points for all 8 parameters)
Interpretation:
• minimum score: 0
• maximum score: 12
• The higher the score the greater the likelihood of a bacterial etiology.
• The performance can be improved by use of additional laboratory tests (CRP, procalcitonin).
|
Total Score |
Diagnosis |
|
<= 2 |
aseptic |
|
3 or 4 |
borderline; antibiotics may be given depending on case |
|
>= 5 |
highly suggestive of a bacterial infection |
Specialty: Infectious Diseases
