Tuerlinckx D, El Hayeck J, Van der Linden D, Bodart E, Glupczynski Y
Département de Pédiatrie, Université Catholique de Louvain, Cliniques Universitaires de Mont Godinne, Yvoir, Belgium.
Acta Clin Belg. 2012 Jul-Aug;67(4):282-5. doi: 10.2143/ACB.67.4.2062673.
The Bacterial Meningitis Score (BMS) is considered as the rule with the highest sensitivity to safely distinguish between aseptic and bacterial meningitis (BM).
The objective of our study was to evaluate the performance of the score and its usefulness for the clinician.
Retrospective analysis of two Belgian academic hospitals-based cohort studies. All consecutive children aged 29 days to 18 years admitted for acute meningitis between January 1996 and December 2008 was eligible. The BMS (risk of bacterial meningitis if seizure, positive cerebrospinal fluid (CSF) Gram staining, CSF protein level (3) 80 mg/dl, CSF neutrophil count 1,000/ mm3 or blood neutrophil count > or = 10,000/mm3) was applied to all patients with meningitis defined by CSF pleocytosis > 8 WBC/mm3.
174 patients were included in the final analysis of whom 26 (15%) had BM. Of the 93 patients categorized as having with no risk for BM (BMS score = 0), 2 patients had BM, one of which had petechial rash (negative predictive value 97.8%). BMS had a sensitivity of 92.3%. Risk of BM was significantly related to the BMS score: 6/147 (4%) patients with BMS < or = 1 had BM compared to 20/27 (74%) patients with BMS > 1.
Our study reports a lower sensitivity of the BMS than observed in previous validation studies. We suggest to include the BMS in a decision tree aiming to optimize the ordering of laboratory investigations including viral and bacterial PCR testing in any child with CSF pleocytosis.
细菌性脑膜炎评分（BMS）被认为是安全区分无菌性脑膜炎和细菌性脑膜炎（BM）时敏感性最高的规则。
我们研究的目的是评估该评分的性能及其对临床医生的有用性。
对两项基于比利时学术医院的队列研究进行回顾性分析。纳入1996年1月至2008年12月期间因急性脑膜炎入院的所有29天至18岁的连续儿童。BMS（如果出现癫痫发作、脑脊液（CSF）革兰氏染色阳性、CSF蛋白水平≥80mg/dl、CSF中性粒细胞计数≥1000/mm³或血液中性粒细胞计数≥10000/mm³，则为细菌性脑膜炎风险）应用于所有脑脊液细胞增多>8个白细胞/mm³定义的脑膜炎患者。
174例患者纳入最终分析，其中26例（15%）患有BM。在93例被归类为无BM风险（BMS评分=0）的患者中，2例患有BM，其中1例有瘀点皮疹（阴性预测值97.8%）。BMS的敏感性为92.3%。BM风险与BMS评分显著相关：BMS≤1的6/147例（4%）患者患有BM，而BMS>1的20/27例（74%）患者患有BM。
我们的研究报告的BMS敏感性低于先前验证研究中观察到的敏感性。我们建议将BMS纳入决策树，旨在优化对任何脑脊液细胞增多儿童的实验室检查顺序，包括病毒和细菌PCR检测。
