Korean J Pediatr.  2015 Jul;58(7):251-255. 10.3345/kjp.2015.58.7.251.

Applying the bacterial meningitis score in children with cerebrospinal fluid pleocytosis: a single center's experience

• Lee J
• Kwon H
• Lee JS
• Kim HD
• Kang HC

• KMID: 2140666
• DOI: http://doi.org/10.3345/kjp.2015.58.7.251

Abstract

PURPOSE
The widespread introduction of bacterial conjugate vaccines has decreased the risk of cerebrospinal fluid (CSF) pleocytosis due to bacterial meningitis (BM) in children. However, most patients with CSF pleocytosis are hospitalized and treated with parenteral antibiotics for several days. The bacterial meningitis score (BMS) is a validated multivariate model derived from a pediatric population in the postconjugate vaccine era and has been evaluated in several studies. In the present study, we examined the usefulness of BMS in South Korean patients.
METHODS
This study included 1,063 patients with CSF pleocytosis aged between 2 months and 18 years. The BMS was calculated for all patients, and the sensitivity and negative predictive value (NPV) of the test were evaluated.
RESULTS
Of 1,063 patients, 1,059 (99.6%) had aseptic meningitis (AM). Only four patients (0.4%) had BM. The majority of patients (98%) had a BMS of < or =1, indicating a diagnosis of AM. The BMS was 0 in 635 patients (60%) and 1 in 405 patients (38%). All four BM patients had a BMS of > or =4.
CONCLUSION
To our knowledge, this is the first study to investigate the diagnostic strength of the BMS in South Korea. In our study, the BMS showed 100% sensitivity and 100% NPV. Therefore, we believe that the BMS is a good clinical prediction rule to identify children with CSF pleocytosis who are at a risk of BM.

Keyword

Aseptic meningitis; Bacterial meningitis; Clinical prediction rule

MeSH Terms

Anti-Bacterial Agents
Cerebrospinal Fluid*
Child*
Decision Support Techniques
Diagnosis
Humans
Korea
Leukocytosis*
Meningitis, Aseptic
Meningitis, Bacterial*
Vaccines, Conjugate
Anti-Bacterial Agents
Vaccines, Conjugate