Bacterial Meningitis in Children

There is a strong predominance in infants younger than two months,1 likely because of the initiation of Haemophilus influenzae type B and pneumococcal vaccines at two months of age. Because an estimated 11% to 28% of meningitis cases are bacterial,2,3 it is important to accurately distinguish between bacterial and nonbacterial meningitis. Dutch Meningitis Prediction Rule to Determine the Need for Lumbar Puncture In Children One Month to 15 Years of Age Item Points Altered consciousness 8 Meningeal irritation 7.5 Cyanosis 6.5 Petechiae 4 Vomiting 2 Duration of main symptom 1 per day (up to 10) Serum C-reactive protein level (mg per dL [mg per L]) < 5 (50) 0 5 to 9.9 (50 to 99) 0.5 10 to 14.9 (100 to 149) 1 15 to 19.9 (150 to 199) 1.5 ≥ 20 (200) 2 Total points: ________ Interpretation Low risk of bacterial meningitis: < 8.5 points At risk of bacterial meningitis: ≥ 8.5 points Adapted with permission from Oostenbrink R, Moons KGM, Derksen-Lubsen AG, et al. In a meta-analysis of validation studies, the rule was found to have a sensitivity of 99.3%, specificity of 62%, negative predictive value of 99.7%, and negative likelihood ratio of 0.01 in a symptomatic population with an overall risk of bacterial meningitis of 23%.3 With the advent of additional biomarkers for serious infection, a group in Spain created an updated clinical prediction rule for children two months to 14 years of age using retrospectively collected data from a derivation population of 819 patients seen in pediatric emergency departments.