Freedman et al developed a simple decision rule for evaluating a child with possible bacterial meningitis. This can help to identify a patient who may benefit from antibiotic therapy. The authors are from the University of Toronto and the Hospital for Sick Children in Toronto.
Patient selection: pediatric patient with suspected bacterial meningitis (ages from 2 months to 17 years)
Parameters:
(1) age of the patient
(2) CSF WBC count
(3) CSF glucose concentration
(4) ratio of CSF glucose to serum glucose
(5) CSF protein concentration
(6) absolute band count in peripheral blood
(7) CSF Gram stain
|
Parameter |
Finding |
Points |
|
age of the patient |
< 6 months |
1 |
|
|
>= 6 months |
0 |
|
CSF WBC count |
<=30 per µL |
0 |
|
|
> 30 per µL |
1 |
|
CSF glucose concentration |
< 40 mg/dL |
1 |
|
|
>= 40 mg/dL |
0 |
|
ratio of CSF to serum glucose |
< 40% |
1 |
|
|
>= 40% |
0 |
|
CSF protein concentration |
<= 45 mg/dL |
0 |
|
|
> 45 mg/dL |
1 |
|
absolute band count |
<= 500 per µL |
0 |
|
|
> 500 per µL |
1 |
|
CSF Gram stain |
negative |
0 |
|
|
positive |
1 |
total number of factors present =
= SUM(points for all 7 parameters)
Interpretation:
• minimum number: 0
• maximum number: 7
• The presence of 1 or more risk factors justifies hospitalization and antibiotic therapy.
Performance in study:
• The sensitivity was 100% and specificity 48%.
Specialty: Infectious Diseases, Neurology
