Nigrovic et al developed a classification tree using recursive partitioning analysis for evaluating a pediatric patient with meningitis. This can help separate distinguish patients with aseptic from bacterial meningitis. The authors are from Boston Children's Hospital, Harvard University and the University of California in Davis.
NOTE: The same parameters are used in the Bacterial Meningitis Score (described in the previous section).
Patient selection: 29 days to 19 years old
Parameters:
(1) Gram stain of CSF
(2) absolute neutrophil count in the CSF per µL (CSF ANC)
(3) seizures before or at presentation to the hospital
(2) CSF protein in mg/dL
(3) absolute neutrophil count in the peripheral blood per µL
|
Gram Stain |
CSF ANC |
Seizure |
CSF Protein |
Blood ANC |
Node |
|
positive |
NA |
NA |
NA |
NA |
A |
|
negative |
>= 1,000 |
NA |
NA |
NA |
B |
|
negative |
< 1,000 |
Yes |
NA |
NA |
C |
|
negative |
< 1,000 |
No |
>= 80 |
NA |
D |
|
negative |
< 1,000 |
No |
< 80 |
>= 10,000 |
E |
|
negative |
< 1,000 |
No |
< 80 |
< 10,000 |
F |
|
Node |
Percent with Bacterial Meningitis |
|
A |
97% |
|
B |
71% |
|
C |
20% |
|
D |
7% |
|
E |
4% |
|
F |
0.8% |
Specialty: Infectious Diseases, Neurology
