Patients presenting with community-acquired bacterial meningitis can be separated into 3 stages of prognostic severity. Patients presenting to the Emergency Room should have antibiotic therapy started as soon as possible.
Risk factors:
(1) hypotension
(1a) systolic blood pressure <= 90 mm Hg, OR
(1b) drop in systolic blood pressure >= 40 mm Hg
(2) altered mental status
(2a) lethargy, OR
(2b) disorientation, OR
(2c) coma
(3) seizures
Adverse clinical outcomes – either one of the following:
(1) death
(2) neurologic deficit (hearing loss, major motor deficit, cranial nerve palsy, impaired cognition, impaired speech, ataxia) present at discharge
number of risk factors =
= SUM(risk factors present)
Interpretation:
• minimum score: 0
• maximum score: 3
• Adverse clinical outcome is more common in patients who progress from prognostic stage I or II to stage III before appropriate antibiotic therapy is started.
Number of Risk Factors
Prognostic Stage
Risk Subgroup
Adverse Outcome
0
I
low
9%
1
II
intermediate
33%
2 or 3
III
high
57%
Table 4, page 865
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