Applying the bacterial meningitis score in children with cerebrospinal fluid pleocytosis: a single center's
Jungpyo Lee1, Hyeeun Kwon2, Joon Soo Lee3
1Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea.
Insights
The bacterial meningitis score (BMS) effectively identifies children with cerebrospinal fluid (CSF) pleocytosis who are not at risk for bacterial meningitis (BM). This validated tool demonstrates high sensitivity and negative predictive value in South Korean pediatric patients.
Area of Science:
- Pediatrics
- Infectious Diseases
- Clinical Diagnostics
Background:
- Bacterial conjugate vaccines have reduced bacterial meningitis (BM) in children, but cerebrospinal fluid (CSF) pleocytosis still requires evaluation.
- Most children with CSF pleocytosis are hospitalized for extended antibiotic treatment.
- The bacterial meningitis score (BMS) is a validated tool for predicting BM in the post-vaccine era.
Purpose of the Study:
- To evaluate the diagnostic utility of the bacterial meningitis score (BMS) in South Korean pediatric patients with CSF pleocytosis.
- To assess the sensitivity and negative predictive value (NPV) of the BMS in this population.
Main Methods:
- A retrospective study of 1,063 pediatric patients (2 months to 18 years) with CSF pleocytosis.
- Calculation of the BMS for all included patients.
- Evaluation of the BMS's sensitivity and NPV for diagnosing bacterial meningitis.
Main Results:
- Only 0.4% of patients (4 out of 1,063) were diagnosed with bacterial meningitis (BM).
- The vast majority (98%) had aseptic meningitis (AM), with most scoring ≤1 on the BMS.
- All four BM cases had a BMS of ≥4, while AM cases predominantly had BMS of 0 or 1.
Conclusions:
- The BMS demonstrated 100% sensitivity and 100% NPV in identifying children with CSF pleocytosis at risk for BM in South Korea.
- The BMS is a reliable clinical prediction rule for differentiating bacterial meningitis from other causes of CSF pleocytosis in children.
- This study is the first to validate the BMS in the South Korean pediatric population.
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 ≤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 ≥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.
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