Guidelines Identify Children with Meningitis

A standard battery of five tests is highly accurate in detecting the difference between viral meningitis and more dangerous bacterial meningitis, according to a report in the Journal of the American Medical Association. The tests are called the Bacterial Meningitis Score, and include review of white blood cell counts, history of seizures, and three tests of fluid surrounding the brain and spinal cord (CSF).

In the study, 1,714 patients were categorized as very low risk by the Bacterial Meningitis Score. Of this group, only two actually had bacterial meningitis, showing the tests to be extremely accurate.

Said principal investigator Dr. Lise E. Nigrovic, an attending physician in pediatric emergency medicine at Children's Hospital Boston:

"The previously published and derived 'decision rule' worked well or better than anything else we could come up with. It's the most accurate clinical prediction rule to discriminate between bacterial and viral meningitis."

Dr. Nathan Litman, director of pediatrics and pediatric infectious diseases at Children's Hospital at Montefiore Medical Center in New York City, added:

"This would support some clinicians - particularly [those] seeing an older child with what looks like viral meningitis - in saying, 'I don't really need to hospitalize this child now, I can follow him as an outpatient... potentially saving costly hospitalization and potentially avoiding initiating an IV line of antibiotics that would be unnecessary."

This research arrived just as Rhode Island government officials ordered 20,000 public school students in three communities to stay home for the rest of the week, after a child attending one of the schools was admitted to a local hospital with a probable case of meningitis. Another student, a second-grader from West Warwick, died from a related disorder, encephalitis, last month. Epidemiologists from the U.S. Centers for Disease Control are already in the communities to talk to school nurses and look for additional cases in local hospitals.

Officials called this level of caution warranted, given how contagious meningitis can be, and how serious it can be when contracted. Dr. Nigrovic said plainly, "Bacterial meningitis is a potentially life-threatening and serious condition which requires intravenous antibiotics at hospital admission."

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