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Review
. 2016 Apr 19:8:7-16.
doi: 10.2147/OAEM.S69975. eCollection 2016.

Clinical decision rules for acute bacterial meningitis: current insights

Alain Viallon  1 , Elisabeth Botelho-Nevers  2 , Fabrice Zeni  3
Affiliations
Review

Clinical decision rules for acute bacterial meningitis: current insights

Alain Viallon et al. Open Access Emerg Med. .

Abstract

Acute community-acquired bacterial meningitis (BM) requires rapid diagnosis so that suitable treatment can be instituted within 60 minutes of admitting the patient. The cornerstone of diagnostic examination is lumbar puncture, which enables microbiological analysis and determination of the cerebrospinal fluid (CSF) cytochemical characteristics. However, microbiological testing is not sufficiently sensitive to rule out this diagnosis. With regard to the analysis of standard CSF cytochemical characteristics (polymorphonuclear count, CSF glucose and protein concentration, and CSF:serum glucose), this is often misleading. Indeed, the relatively imprecise nature of the cutoff values for these BM diagnosis markers can make their interpretation difficult. However, there are two markers that appear to be more efficient than the standard ones: CSF lactate and serum procalcitonin levels. Scores and predictive models are also available; however, they only define a clinical probability, and in addition, their use calls for prior validation on the population in which they are used. In this article, we review current methods of BM diagnosis.

Keywords: diagnosis; emergency; meningitis.

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Figures

Figure 1
Figure 1
Making decisions on clinical parameters and cerebrospinal fluid. Notes: European Federation of Neurological Societies guidelines specified: patents suspected to have raised intracranial pressure on symptoms and signs. Abbreviations: CT, computed tomography; CSF, cerebrospinal fluid; PCT, procalcitonin.
See this image and copyright information in PMC

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