Spain: The meningitis score for emergencies (MSE) can be used for accurate distinction of bacterial from aseptic meningitis in children having cerebrospinal fluid (CSF) pleocytosis, suggests a recent study in the AAP journal Pediatrics.
New biomarkers such as C-reactive protein and procalcitonin may help in designing support tool used for identifying children with pleocytosis at high or low risk of of bacterial meningitis. Santiago Mintegi, Universidad del País Vasco/Euskal Herriko Unibertsitatea, Bilbao, Basque Country, Spain, and colleagues aimed to develop and validate a score (called MSE) to differentiate bacterial meningitis from aseptic meningitis in children with pleocytosis.
The study included 1009 children (aged between 29 days and 14 years) with meningitis admitted to 25 Spanish emergency departments. A retrospective cohort from between 2011 and 2016 was used as the derivation set and a prospective cohort recruited during 2017 and 2018 was used as the validation set.
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Key findings of the study include:
There were 917 cases of aseptic meningitis and 92 of bacterial meningitis.
Using multivariable logistic regression analysis, the researchers identified the following predictors of bacterial meningitis from the derivation set: procalcitonin >1.2 ng/mL, cerebrospinal fluid (CSF) protein >80 mg/dL, CSF absolute neutrophil count >1000 cells per mm3, and C-reactive protein >40 mg/L.
Using the derivation set, the researchers developed the MSE, assigning 3 points for procalcitonin, 2 points for CSF protein, and 1 point for each of the other variables. An MSE ≥1 predicted bacterial meningitis with a sensitivity of 100%, a specificity of 83.2, and a negative predictive value of 100%.
"Our findings demonstrate that the MSE accurately distinguishes bacterial from aseptic meningitis in children with CSF pleocytosis," concluded the authors.
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The study "Clinical Prediction Rule for Distinguishing Bacterial From Aseptic Meningitis," is published in the American Academy of Pediatrics (AAP) journal Pediatrics.
DOI: https://pediatrics.aappublications.org/content/146/3/e20201126