Dubos F, Lamotte B, Bibi-Triki F, Moulin F, Raymond J, Gendrel D, Bréart G, Chalumeau M
Clinical Epidemiology Unit, Department of Paediatrics, Saint Vincent-de-Paul Hospital, AP-HP, Paris Descartes University, Paris, France.
Arch Dis Child. 2006 Aug;91(8):647-50. doi: 10.1136/adc.2005.085704. Epub 2006 Apr 4.
Clinical decision rules have been derived to distinguish between bacterial and aseptic meningitis in the emergency room to avoid unnecessary antibiotic treatments and hospitalisations.
To evaluate the reproducibility and to compare the diagnostic performance of five clinical decision rules.
All children hospitalised for bacterial meningitis between 1995 and 2004 or aseptic meningitis between 2000 and 2004 have been included in a retrospective cohort study. Sensitivity and specificity were calculated by applying each rule to the patients. The best rule was a priori defined as the one yielding 100% sensitivity for bacterial meningitis, the highest specificity, and the greatest simplicity for a bedside application.
Among the 166 patients included, 20 had bacterial meningitis and 146 had aseptic meningitis. Although three rules achieved 100% sensitivity (95% CI 84-100), one had a significantly lower specificity (13%, 95% CI 8-19) than those of the other two rules (57%, 95% CI 48-65; and 66%, 95% CI 57-73), which were not statistically different. The ease of manual computation of the rule developed by Nigrovic et al (a simple list of five items: seizure, blood neutrophil count, cerebrospinal fluid (CSF) Gram stain, CSF protein, CSF neutrophil count) was higher than the one developed by Bonsu and Harper.
On our population, the rule derived by Nigrovic et al had the best balance between accuracy and simplicity of manual computation and could help to avoid two thirds of unnecessary antibiotic treatments and hospitalisations.
已制定临床决策规则，以在急诊室区分细菌性脑膜炎和无菌性脑膜炎，避免不必要的抗生素治疗和住院。
评估五项临床决策规则的可重复性，并比较其诊断性能。
1995年至2004年因细菌性脑膜炎住院或2000年至2004年因无菌性脑膜炎住院的所有儿童均纳入一项回顾性队列研究。通过将每条规则应用于患者来计算敏感性和特异性。最佳规则预先定义为对细菌性脑膜炎敏感性达100%、特异性最高且床边应用最简便的规则。
纳入的166例患者中，20例患有细菌性脑膜炎，146例患有无菌性脑膜炎。尽管有三条规则的敏感性达到了100%（95%可信区间84 - 100），但其中一条规则的特异性（13%，95%可信区间8 - 19）显著低于其他两条规则（57%，95%可信区间48 - 65；以及66%，95%可信区间57 - 73），后两条规则在统计学上无差异。Nigrovic等人制定的规则（一个包含五项的简单列表：癫痫发作、血液中性粒细胞计数、脑脊液（CSF）革兰氏染色、CSF蛋白、CSF中性粒细胞计数）手动计算的简便性高于Bonsu和Harper制定的规则。
在我们的研究人群中，Nigrovic等人制定的规则在准确性和手动计算简便性之间达到了最佳平衡，有助于避免三分之二不必要的抗生素治疗和住院。
