Weisfelt et al developed a risk score for identifying an adult with bacterial meningitis who may have an unfavorable outcome. This can help to identify a patient who may benefit from more aggressive management. The authors are from the Academic Medical Center in Amsterdam, The Netherlands.
Patient selection: age > 16 years with positive CSF culture for bacteria
Unfavorable outcomes: Glasgow Outcome Score (GOS) <= 4 or death:
Parameters:
(1) age in years
(2) tachycardia
(3) Glasgow Coma Score (GCS)
(4) cranial nerve palsy
(5) leukocyte count in the CSF
(6) Gram stain findings on the CSF
|
Parameter |
Finding |
Points |
|
age |
20 |
0 |
|
|
30 |
2 |
|
|
40 |
4 |
|
|
50 |
5 |
|
|
60 |
6 |
|
|
70 |
10 |
|
|
80 |
12 |
|
tachycardia |
absent |
0 |
|
|
present |
10 |
|
GCS |
15 |
0 |
|
|
14 |
1 |
|
|
13 |
2 |
|
|
12 |
4 |
|
|
11 |
5 |
|
|
10 |
6 |
|
|
9 |
8 |
|
|
8 |
9 |
|
|
7 |
10 |
|
|
6 |
12 |
|
|
5 |
13 |
|
|
4 |
14 |
|
|
3 |
16 |
|
cranial nerve palsy |
no |
0 |
|
|
yes |
9 |
|
CSF leukocyte count |
high (>= 1,000 per µL) |
0 |
|
|
low (< 1,000 per µL) |
13 |
|
Gram stain findings |
Gram-positive cocci |
12 |
|
|
Gram-negative cocci |
0 |
|
|
other (bacilli, etc) |
2 |
|
|
no bacteria seen |
1 |
Age can be restated as:
|
Age |
Points |
|
< 20 |
0 |
|
20 to 80 |
(0.2 * (age) - 4 |
|
> 80 |
12 |
total score =
= SUM(points for all 6 paraemters)
Interpretation:
• minimum score: 0
• maximum score 72
• The higher the score the greater the chance of an unfavorable outcome.
|
Total Score |
Risk of Unfavorable Outcome in Percent |
|
< 5 |
< 3.2% |
|
5 to 25 |
(0.04 * ((score)^2)) - (0.008 * (score)) + 4.18 |
|
25 to 45 |
(2.32 * (score)) - 29.20 |
|
45 to 65 |
(-0.03429 * ((score)^2)) + (4.811 * (score)) - 72 |
|
> 65 |
> 96% |
Specialty: Infectious Diseases, Neurology
