Abstract

Meningitis is a potentially life-threatening condition characterized by infection or
inflammation of the central nervous system. It is classified as bacterial, viral, or aseptic.
Delayed or untreated bacterial meningitis is associated with high morbidity and mortality. It
is important to accurately distinguish between bacterial and nonbacterial meningitis. Most
physicians will perform a lumbar puncture and consider antibiotics for all infants and
children with suspected meningitis. Having a clinical prediction rule to determine the need
for lumbar puncture and which patients need antibiotics could reduce morbidity and the cost
associated with unnecessary procedures and treatment. Several clinical prediction rules to
determine the risk of bacterial meningitis have been proposed. One clinical prediction rule,
derived and validated from cohorts seen in pediatric hospitals in the Netherlands, found that
altered consciousness, meningeal irritation, cyanosis, petechiae, vomiting, duration of main
symptom, and an elevated C-reactive protein and Erythrocyte Sedimentation Rate level were
independent predictors of bacterial meningitis. Patients below a predefined threshold on a
risk score incorporating these elements could be safely considered as not having bacterial
meningitis