Dubos et al reported the Meningitest, a clinical rule for starting antibiotics in a child with suspected meningitis. This was based on the rule of Nigrovic et al.
The name Meningitest is registered.
Exclusion criteria: neurosurgical history; immunosuppression; pretreatment with antibiotics; septic shock; CSF RBC count > 10 * 10^9/L
Indications to start antibiotic therapy - one or more of the following.
(1) seizures
(2) purpura
(3) toxic appearance
(4) serum procalcitonin concentration >= 0.5 ng/mL
(5) positive Gram stain of the CSF
(6) CSF protein concentration >= 50 mg/dL
Performance:
• The sensitivity was 100%.
• The specificity was 62% in the derivation set and 51% in the internal validation set.
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