Bonsu et al reported a simple clinical decision rule for the diagnosis of bacterial meningitis in children. This is based on laboratory data and assumes that a Gram stain result is not available. The authors are from Columbus Children's Hospital, Children's Hospital and Clinics of Minnesota, and Children's Hospital Boston.
Patient selection: child with CSF pleocytosis and without Gram stain findings (age range for children with bacterial meningitis was 0.4 to 2.2 years; age range for children with enteroviral meningitis was 0.2 to 9.9 years)
Parameters:
(1) CSF leukocyte count per µL
(2) percent neutrophils in the CSF
(3) CSF glucose in mg/dL
(4) CSF protein in mg/dL
(5) WBC count in peripheral blood
(6) ratio of bands to neutrophils (absolute neutrophil count) in the peripheral blood
ratio of bands to neutrophils as percent =
= (percent bands) / (percent neutrophils) * 100%
Parameter
Finding
Points
CSF leukocyte count
<= 597 per µL
0
> 597 per µL
1
percent neutrophils in CSF
<= 74%
0
> 74%
1
CSF glucose
>= 38 mg/dL
0
< 38 mg/dL
1
CSF protein
<= 97 mg/dL
0
> 97 mg/dL
1
WBC count in blood
<= 17,000 per µL
0
> 17,000 per µL
1
ratio of bands to neutrophils
<= 11%
0
> 11%
1
total score =
= SUM(points for all 6 parameters)
Interpretation:
• minimum score: 0
• maximum score: 6
• The higher the score the greater the risk of bacterial meningitis.
Score
Bacterial Meningitis
0
0%
1
3%
2
11%
3
19%
>= 4
68%
Performance:
• The authors report that the area under the ROC curve ranges from 0.90 to 0.98 depending on the cohort.
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