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Bacterial Meningitis Score for Children

Calculators  Neurology
The bacterial meningitis score is used to establish the risk of having bacterial meningitis when symptoms of meningitis are present in children aged aged 29 days to 19 years.
Cerebrospinal fluid (CSF) Gram stain positive
No 0
Yes 1
Cerebrospinal fluid (CSF) protein ≥80 mg/dL
No 0
Yes 1
Seizure prior to or at initial presentation
No 0
Yes 1
Result:

Background

Measured Factor
risk of having bacterial meningitis
Measured Factor Disease
  • bacterial meningitis
Measured Factor Detail
This test uses several pieces of information to establish a risk of having bacterial meningitis when symptoms of meningitis are present. The information used includes Cerebrospinal fluid (CSF) gram stain, CSF absolute neutrophil count (ANC) count, CSF protein, peripheral ANC count, and history of seizure. Each item is given one point. If the child is at very low risk (score =0), unnecessary hospitalization and antibiotic use may be avoided.
Speciality
Pediatric Neurologist
Body System
Neurology
Measured Factor High Impact
  • high risk of having bacterial meningitis

Result Interpretation

Ranges Ranges
  • Critical High: 1
  • Normal: 0
  • Normal Pediatric: 0
  • Normal Neonate Female: 0
Result High Conditions
  • bacterial meningitis
Test Limitations
The bacterial meningitis score is limited to predicting the need for antibiotics in children, and does not encompass other causes for antibiotics or other populations. Caution against the use of the Bacterial Meningitis Score for infants younger than 2 months is advised because the Bacterial Meningitis Score may be less accurate in this population. I In a study assessing the efficacy of the bacterial meningitis score, two children were missed that did in fact have bacterial meningitis. Although the number was very low compared to the number of children that did have a positive score, it is still important to ensure a proper diagnosis and treamtent regardless of the prediction.
References: 1

Studies

Study Validation 1
This study analyzed the accuracy of the bacterial meningitis score in a meta analysis that included all studies from 2002-2012. The study included analysis of 4896 children, and bacterial meningitis was diagnosed in 1242 patients. The sensitivity of the bacterial meningitis score was very high at 99.3%. The specificity was 62.1%.The study concludes that the bacterial meningitis score is highly accurate in predicting bacterial meningitis in children.
References: 2
Study Validation 2
This study examined the efficacy of the bacterial meningitis score in children aged 29 days to 19 years. The score was based on each of the variables receiving 1 point except for the positive gram stain which was assigned 2 points. The score accurately described all children who did not have bacterial meningitis, with a negative predictive value  of a score of 0 for bacterial meningitis was 100%. A score greater than or  equal to 2 predicted bacterial meningitis with a sensitivity of 87%. The study concluded that the bacterial meningitis score was accurate to determine high risk and low risk among children with meningitis symptoms, and outpatient observation may be possible in the low risk group of children.
References: 3
Study Validation 3
This study compared the rule developed by Nigrovic et al, Freedman et al,  and Bonsu and Harper to distinguish between bacterial and aseptic meningitis. The study showed that the use of all three rules achieved a 100% sensitivity. The rule developed by Freedman et al had only 13% specificity (p < 0.001). The specificities of the other  two rules, by Bonsu and Harper and by Nigrovic et al, were 57% and 66% respectively (p = 0.15). The researchers concluded that this rule developed by by Nigrovic et al.  was easy to use, making it very practical in the workplace, and due to its high accuracy, is a valuable tool for healthcare providers when screening children for bacterial meningitis. The study called for more analysis with larger samples, but maintained that the bacterial meningitis score is accurate and highly effective.
References: 4
Study Additional 1
This study analyzed the use of different scoring systems to accurately predict the incidence of bacterial meningitis in children. The study looked at six different kinds of tests to predict meningitis. Of all the tests, the bacterial meningitis score achieved the best quality and performance. The study recommended further research, including performing prospective studies rather than retrospective studies. Overall, the bacterial meningitis score was found to be highly accurate, but should not be used as the only tool to diagnose or treat a child with suspected meningitis.
References: 5
Study Additional 2
In a study that compared the use of bacterial meningitis score to the meningitest, both were found to have 100% sensitivity in predicting bacterial meningitis. However, the study showed that the bacterial meningitis score had a much higher specificity (52%), than the meningitest (36%, p<10(-)8); therefore the bacterial meningitis score is more applicable to the workplace. The study recommends caution in the use of either test, but the researchers concluded that the bacterial meningitis score was accurate and could greatly reduce the amount of unnecessary antibiotic use.
References: 6
Study Additional 3
A study assessed the accuracy of the bacterial meningitis score among a sample of 3295 children. The bacterial meningitis score predicted 1714 children to be very low risk for bacterial meningitis, and of those children, 2 had bacterial meningitis. This showed the bacterial meningitis score to have a sensitivity of 98.3%. The negative predicitve value was 99.9%. The researchers concluded that the bacterial meningitis score is an accurate tool to guide healthcare providers in assessing a child for bacterial meningitis.
References: 7

Authors

Lise E. Nigrovic, MD, MPH, is an associate professor and a physician of pediatrics and emergency medicine at Harvard Medical School. She also serves as the co-director for the Population Science Center. Her research focuses on the diagnosis and management of children with infectious and traumatic emergencies. She currently studies the diagnosis of Lyme disease in children
http://www.childrenshospital.org/research/researchers/n/lise-nigrovic

References

  1. Nigrovic LE, Kuppermann N, Macias CG, Cannavino CR, Moro-Sutherland DM, Schremmer RD, et al.; Pediatric Emergency Medicine Collaborative Research Committee of the American Academy of Pediatrics. Clinical prediction rule for identifying children with cerebrospinal fluid pleocytosis at very low risk of bacterial meningitis. JAMA. 2007 Jan 3;297(1):52-60.
  2. Nigrovic LE, Malley R, Kuppermann N. Meta-analysis of bacterial meningitis score validation studies.Arch Dis Child. 2012 Sep;97(9):799-805.
  3. Nigrovic LE, Kuppermann N, Malley R. Development and validation of a multivariable predictive model to distinguish bacterial from aseptic meningitis in children in the post-Haemophilus influenzae era. Pediatrics. 2002 Oct;110(4):712-9.
  4. Dubos F, Lamotte B, Bibi-Triki F, Moulin F, Raymond J, Gendrel D, et al. Clinical decision rules to distinguish between bacterial and aseptic meningitis. Arch Dis Child. 2006 Aug;91(8):647-50.
  5. Kulik DM, Uleryk EM, Maguire JL. Does this child have bacterial meningitis? A systematic review of clinical prediction rules for children with suspected bacterial meningitis. J Emerg Med. 2013 Oct;45(4):508-19.
  6. Dubos F, Korczowski B, Aygun DA, Martinot A, Prat C, Galetto-Lacour A, et al. Distinguishing between bacterial and aseptic meningitis in children: European comparison of two clinical decision rules. Arch Dis Child. 2010 Dec;95(12):963-7.
  7. Nigrovic LE, Kuppermann N, Macias CG, Cannavino CR, Moro-Sutherland DM, Schremmer RD, et al. Clinical prediction rule for identifying children with cerebrospinal fluid pleocytosis at very low risk of bacterial meningitis. JAMA. 2007 Jan 3;297(1):52-60.