Division of Emergency Medicine, Department of Pediatrics, Children's Hospital Boston and Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA.
Arch Dis Child. 2012 Sep;97(9):799-805. doi: 10.1136/archdischild-2012-301798. Epub 2012 Jul 4.
The Bacterial Meningitis Score, a derived and validated clinical decision rule, identifies children with cerebrospinal fluid (CSF) pleocytosis who are at very low risk of bacterial meningitis. Low-risk features include the following: negative CSF Gram stain, CSF absolute neutrophil count (ANC) <1000 cells/μl, CSF protein <80 mg/dl, peripheral blood ANC <10 000 cells/μl and no seizure at or prior to initial presentation. The study objective of the present work was to calculate the performance of the Bacterial Meningitis Score by performing a meta-analysis of all published validation studies.
A meta-analysis of all studies published between 2002 and 2012 was performed, evaluating the performance of the Bacterial Meningitis Score in children with CSF pleocytosis. Study quality was assessed using the assessment of diagnostic accuracy studies instrument and then the test performance of the prediction rule was calculated.
From 8 studies, 5312 patients were identified, of whom 4896 (92%) had sufficient clinical data to calculate the Bacterial Meningitis Score. Bacterial meningitis was diagnosed in 1242 children (23% of study patients). The combined sensitivity of the Bacterial Meningitis Score for bacterial meningitis was 99.3% (1224/1233; 95% CI 98.7% to 99.7%), specificity 62.1% (2274/3663; 95% CI 60.5% to 63.7%) negative predictive value 99.7% (2274/2283, 95% CI 99.3% to 99.9%), positive likelihood ratio 2.6 (95% CI 2.5 to 2.7) and negative likelihood ratio 0.01 (95% CI 0.01 to 0.02).
The Bacterial Meningitis Score is a highly accurate clinical scoring system that could be used to assist clinical decision making for the management of children with CSF pleocytosis.
细菌性脑膜炎评分是一种衍生的、经过验证的临床决策规则，可以识别脑脊液（CSF）白细胞增多症中发生细菌性脑膜炎风险极低的儿童。低风险特征包括以下几点：CSF 革兰氏染色阴性、CSF 绝对中性粒细胞计数（ANC）<1000 个/μl、CSF 蛋白<80mg/dl、外周血 ANC<10000 个/μl 且初始表现时或之前无癫痫发作。本研究的目的是通过对所有已发表的验证研究进行荟萃分析来计算细菌性脑膜炎评分的性能。
对 2002 年至 2012 年间发表的所有研究进行荟萃分析，评估细菌性脑膜炎评分在 CSF 白细胞增多症患儿中的表现。使用诊断准确性研究工具评估研究质量，然后计算预测规则的测试性能。
从 8 项研究中，确定了 5312 名患者，其中 4896 名（92%）有足够的临床数据来计算细菌性脑膜炎评分。在 1242 名患儿（研究患者的 23%）中诊断为细菌性脑膜炎。细菌性脑膜炎评分对细菌性脑膜炎的综合敏感性为 99.3%（1224/1233；95%CI 98.7%至 99.7%），特异性为 62.1%（2274/3663；95%CI 60.5%至 63.7%），阴性预测值为 99.7%（2274/2283，95%CI 99.3%至 99.9%），阳性似然比为 2.6（95%CI 2.5 至 2.7），阴性似然比为 0.01（95%CI 0.01 至 0.02）。
细菌性脑膜炎评分是一种高度准确的临床评分系统，可用于协助 CSF 白细胞增多症患儿的临床决策制定。
