[A diagnostic decision rule for managing children with signs of meningeal irritation].

Abstract

OBJECTIVE:

To develop a diagnostic decision rule based on clinical features to predict the risk of bacterial meningitis in children with signs of meningeal irritation.

DESIGN:

Retrospective and prospective.

METHOD:

Predictors for bacterial meningitis were identified by collecting clinical data from the records of 360 patients (aged 1 month to 15 years) who consulted the Casualty Department, Sophia Children's Hospital, Rotterdam, the Netherlands, with signs of meningeal irritation during the period 1988-1998. The diagnostic decision rule derived was prospectively validated on 226 similar children who consulted the casualty departments of four hospitals in the Netherlands during the period 1999-2001.

RESULTS:

Predictors for bacterial meningitis were the main complaint and vomiting (in the history) persisting for a long time, the presence of meningeal irritation, cyanosis, petechiae, disturbed consciousness (during physical examination), and a high serum concentration of C-reactive protein. Liquor analysis parameters with an added diagnostic value were the total polymorphonuclear cell count in the liquor and the liquor/blood glucose ratio. The use of these patient characteristics in a decision rule accurately predicted the chance of bacterial meningitis. The rule can also be used to refine the indication for lumbar puncture and empirical antibiotic treatment.

• Authors: R Oostenbrink, K G Moons, G Derksen-Lubsen, D E Grobbee, H A Moll
• Journal: Nederlands tijdschrift voor geneeskunde (Ned Tijdschr Geneeskd) Vol. 147 Issue 28 Pg. 1357-61 (Jul 12 2003) ISSN: 0028-2162 [Print] Netherlands
• Vernacular Title: Een diagnostische beslisregel voor kinderen met tekenen van meningeale prikkeling.
• PMID: 12892012 (Publication Type: English Abstract, Journal Article)

Chemical References

• C-Reactive Protein

Topics

• Adolescent
• C-Reactive Protein (analysis)
• Child
• Child, Preschool
• Diagnosis, Differential
• Female
• Humans
• Infant
• Infant, Newborn
• Male
• Medical History Taking
• Meningitis, Bacterial (blood, diagnosis)
• Netherlands
• Physical Examination
• Practice Guidelines as Topic
• Prospective Studies
• Retrospective Studies
• Risk Factors
• Vomiting (etiology)