Nederlands tijdschrift voor geneeskunde · 2003
[A diagnostic decision rule for managing children with signs of meningeal irritation].
Аннотация на английскомСтатьяНазвание и аннотация: Перевод в очереди
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Oostenbrink R, Moons K G, Derksen-Lubsen G, Grobbee D E, Moll H A
Аннотация
OBJECTIVE: To develop a diagnostic decision rule based on clinical features to predict the risk of bacterial meningitis in children with signs of meningeal irritation.
DESIGN: Retrospective and prospective.
METHOD: Predictors for bacterial meningitis were identified by collecting clinical data from the records of 360 patients (aged 1 month to 15 years) who consulted the Casualty Department, Sophia Children's Hospital, Rotterdam, the Netherlands, with signs of meningeal irritation during the period 1988-1998. The diagnostic decision rule derived was prospectively validated on 226 similar children who consulted the casualty departments of four hospitals in the Netherlands during the period 1999-2001.
RESULTS: Predictors for bacterial meningitis were the main complaint and vomiting (in the history) persisting for a long time, the presence of meningeal irritation, cyanosis, petechiae, disturbed consciousness (during physical examination), and a high serum concentration of C-reactive protein. Liquor analysis parameters with an added diagnostic value were the total polymorphonuclear cell count in the liquor and the liquor/blood glucose ratio. The use of these patient characteristics in a decision rule accurately predicted the chance of bacterial meningitis. The rule can also be used to refine the indication for lumbar puncture and empirical antibiotic treatment.
DESIGN: Retrospective and prospective.
METHOD: Predictors for bacterial meningitis were identified by collecting clinical data from the records of 360 patients (aged 1 month to 15 years) who consulted the Casualty Department, Sophia Children's Hospital, Rotterdam, the Netherlands, with signs of meningeal irritation during the period 1988-1998. The diagnostic decision rule derived was prospectively validated on 226 similar children who consulted the casualty departments of four hospitals in the Netherlands during the period 1999-2001.
RESULTS: Predictors for bacterial meningitis were the main complaint and vomiting (in the history) persisting for a long time, the presence of meningeal irritation, cyanosis, petechiae, disturbed consciousness (during physical examination), and a high serum concentration of C-reactive protein. Liquor analysis parameters with an added diagnostic value were the total polymorphonuclear cell count in the liquor and the liquor/blood glucose ratio. The use of these patient characteristics in a decision rule accurately predicted the chance of bacterial meningitis. The rule can also be used to refine the indication for lumbar puncture and empirical antibiotic treatment.