- 作者：Rodrigo Hasbun ; 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
- 关键词：Meningitis ; Risk score ; Urgent treatable cause ; CSF pleocytosis
- 刊名：Journal of Infection
- 出版年：2013
- 出版时间：August, 2013
- 年：2013
- 卷：67
- 期：2
- 页码：102-110
- 全文大小：538 K
Summary
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 (¡Ý1 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.