Nigrovic Lise E, Kuppermann Nathan, Macias Charles G, Cannavino Christopher R, Moro-Sutherland Donna M, Schremmer Robert D, Schwab Sandra H, Agrawal Dewesh, Mansour Karim M, Bennett Jonathan E, Katsogridakis Yiannis L, Mohseni Michael M, Bulloch Blake, Steele Dale W, Kaplan Ron L, Herman Martin I, Bandyopadhyay Subhankar, Dayan Peter, Truong Uyen T, Wang Vincent J, Bonsu Bema K, Chapman Jennifer L, Kanegaye John T, Malley Richard
Department of Medicine, Children's Hospital Boston and Harvard Medical School, Boston, Mass 02115, USA.
JAMA. 2007 Jan 3;297(1):52-60. doi: 10.1001/jama.297.1.52.
Children with cerebrospinal fluid (CSF) pleocytosis are routinely admitted to the hospital and treated with parenteral antibiotics, although few have bacterial meningitis. We previously developed a clinical prediction rule, the Bacterial Meningitis Score, that classifies patients at very low risk of bacterial meningitis if they lack all of the following criteria: positive CSF Gram stain, CSF absolute neutrophil count (ANC) of at least 1000 cells/microL, CSF protein of at least 80 mg/dL, peripheral blood ANC of at least 10,000 cells/microL, and a history of seizure before or at the time of presentation.
To validate the Bacterial Meningitis Score in the era of widespread pneumococcal conjugate vaccination.
DESIGN, SETTING, AND PATIENTS: A multicenter, retrospective cohort study conducted in emergency departments of 20 US academic medical centers through the Pediatric Emergency Medicine Collaborative Research Committee of the American Academy of Pediatrics. All children aged 29 days to 19 years who presented at participating emergency departments between January 1, 2001, and June 30, 2004, with CSF pleocytosis (CSF white blood cells > or =10 cells/microL) and who had not received antibiotic treatment before lumbar puncture.
The sensitivity and negative predictive value of the Bacterial Meningitis Score.
Among 3295 patients with CSF pleocytosis, 121 (3.7%; 95% confidence interval [CI], 3.1%-4.4%) had bacterial meningitis and 3174 (96.3%; 95% CI, 95.5%-96.9%) had aseptic meningitis. Of the 1714 patients categorized as very low risk for bacterial meningitis by the Bacterial Meningitis Score, only 2 had bacterial meningitis (sensitivity, 98.3%; 95% CI, 94.2%-99.8%; negative predictive value, 99.9%; 95% CI, 99.6%-100%), and both were younger than 2 months old. A total of 2518 patients (80%) with aseptic meningitis were hospitalized.
This large multicenter study validates the Bacterial Meningitis Score prediction rule in the era of conjugate pneumococcal vaccine as an accurate decision support tool. The risk of bacterial meningitis is very low (0.1%) in patients with none of the criteria. The Bacterial Meningitis Score may be helpful to guide clinical decision making for the management of children presenting to emergency departments with CSF pleocytosis.
脑脊液（CSF）有细胞增多的儿童通常会住院并接受肠胃外抗生素治疗，尽管很少有人患有细菌性脑膜炎。我们之前制定了一项临床预测规则，即细菌性脑膜炎评分，如果患者不具备以下所有标准，则被归类为细菌性脑膜炎风险极低：脑脊液革兰氏染色阳性、脑脊液绝对中性粒细胞计数（ANC）至少为1000个细胞/微升、脑脊液蛋白至少为80毫克/分升、外周血ANC至少为10000个细胞/微升以及在就诊前或就诊时出现癫痫病史。
在广泛接种肺炎球菌结合疫苗的时代验证细菌性脑膜炎评分。
设计、地点和患者：一项多中心回顾性队列研究，通过美国儿科学会儿科急诊医学协作研究委员会在美国20家学术医疗中心的急诊科进行。所有年龄在29天至19岁之间、于2001年1月1日至2004年6月30日期间在参与研究的急诊科就诊且脑脊液有细胞增多（脑脊液白细胞≥10个细胞/微升）且在腰椎穿刺前未接受抗生素治疗的儿童。
细菌性脑膜炎评分的敏感性和阴性预测值。
在3295例脑脊液有细胞增多的患者中，121例（3.7%；95%置信区间[CI]，3.1%-4.4%）患有细菌性脑膜炎，3174例（96.3%；95%CI，95.5%-96.9%）患有无菌性脑膜炎。在细菌性脑膜炎评分归类为细菌性脑膜炎风险极低的1714例患者中，只有2例患有细菌性脑膜炎（敏感性，98.3%；95%CI，94.2%-99.8%；阴性预测值，99.9%；95%CI，99.6%-100%），且两人均小于2个月大。共有2518例（80%）无菌性脑膜炎患者住院。
这项大型多中心研究验证了在结合肺炎球菌疫苗时代细菌性脑膜炎评分预测规则作为一种准确的决策支持工具。没有任何一项标准的患者患细菌性脑膜炎的风险非常低（0.1%）。细菌性脑膜炎评分可能有助于指导对急诊科出现脑脊液细胞增多的儿童进行管理的临床决策。
