Mintegi et al reported a clinical prediction rule to distinguish bacterial from aseptic meningitis in pediatric patients. The authors are from multiple institutions in Spain.
Patient selection: meningitis, from 29 days to 14 years old
Parameters:
(1) serum procalcitonin in ng/mL
(2) serum CRP in mg/L
(3) CSF absolute neutrophil count per µL
(4) CSF protein in mg/dL
Parameter
Finding
Points
serum procalcitonin
<= 1.20 ng/mL
0
> 1.2 ng/mL
3
serum CRP
<= 40 mg/L
0
> 40 mg/L
1
CSF neutrophil count
<= 1,000 per µL
0
> 1,000 per µL
1
CSF protein
<= 80 mg/dL
0
> 80 mg/dL
2
total score =
= SUM(points for all 4 parameters)
Interpretation:
• minimum score: 0
• maximum score: 7
• A score of 0 or 1 was seen only with aseptic meningitis.
• A score of 2 to 7 was associated with 53% bacterial and 47% aseptic meningitis (Figure 1).
• The CSF gram stain is positive in about 75% of cases of bacterial meningitis.
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