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. 2013 Aug;67(2):102-10.
doi: 10.1016/j.jinf.2013.04.002. Epub 2013 Apr 22.

Risk score for identifying adults with CSF pleocytosis and negative CSF Gram stain at low risk for an urgent treatable cause

Rodrigo Hasbun  1 , Merijn Bijlsma, Matthijs C Brouwer, Nabil Khoury, Christiane M Hadi, Arie van der Ende, Susan H Wootton, Lucrecia Salazar, Md Monir Hossain, Mark Beilke, Diederik van de Beek
Affiliations

Risk score for identifying adults with CSF pleocytosis and negative CSF Gram stain at low risk for an urgent treatable cause

Rodrigo Hasbun et al. J Infect. 2013 Aug.

Abstract

Background: We aimed to derive and validate a risk score that identifies adults with cerebrospinal fluid (CSF) pleocytosis and a negative CSF Gram stain at low risk for an urgent treatable cause.

Methods: Patients with CSF pleocytosis and a negative CSF Gram stain were stratified into a prospective derivation (n = 193) and a retrospective validation (n = 567) cohort. Clinically related baseline characteristics were grouped into three composite variables, each independently associated with a set of predefined urgent treatable causes. We subsequently derived a risk score classifying patients into low (0 composite variables present) or high (≥ 1 composite variables present) risk for an urgent treatable cause. The sensitivity of the risk score was determined in the validation cohort and in a prospective case series of 214 adults with CSF-culture proven bacterial meningitis, CSF pleocytosis and a negative Gram stain.

Findings: A total of 41 of 193 patients (21%) in the derivation cohort and 71 of 567 (13%) in the validation cohort had an urgent treatable cause. Sensitivity of the dichotomized risk score to detect an urgent treatable cause was 100.0% (95% CI 93.9-100.0%) in the validation cohort and 100.0% (95% CI 97.8-100.0%) in bacterial meningitis patients.

Interpretation: The risk score can be used to identify adults with CSF pleocytosis and a negative CSF Gram stain at low risk for an urgent treatable cause.

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Figures

Figure 1
Figure 1
Grouping of baseline variables into composite variables.
Figure 2
Figure 2
Flowcharts of patient inclusion in derivation cohort (A) and validation cohort (B).
See this image and copyright information in PMC

References

    1. Elmore JG, Horwitz RI, Quagliarello VJ. Acute meningitis with a negative Gram's stain: clinical and management outcomes in 171 episodes. Am J Med. 1996;100:78–84. - PubMed
    1. Hasbun R. The Acute Aseptic Meningitis Syndrome. Curr Infect Dis Rep. 2000;2:345–51. - PubMed
    1. Lepow ML, Carver DH, Wright HT, Jr., Woods WA, Robbins FC. A clinical, epidemiologic and laboratory investigation of aseptic meningitis during the four-year period, 1955-1958. I. Observations concerning etiology and epidemiology. N Engl J Med. 1962;266:1181–7. - PubMed
    1. Viallon A, Desseigne N, Marjollet O, et al. Meningitis in adult patients with a negative direct cerebrospinal fluid examination: value of cytochemical markers for differential diagnosis. Crit Care. 2011;15:R136. - PMC - PubMed
    1. Brouwer MC, Tunkel AR, van de Beek D. Epidemiology, diagnosis, and antimicrobial treatment of acute bacterial meningitis. Clin Microbiol Rev. 2010;23:467–92. - PMC - PubMed

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