The differential diagnosis
between viral meningitis
and bacterial meningitis
is often very difficult. The results of peripheral blood
and spinal fluid analysis are not 100% accurate. We tried to find a useful ‘bedside’ decision-making tool, based on laboratory results readily available at the emergency department.
Retrospective study design. Analysis of a consecutive series of all children (age 0–15 years) admitted to the paediatric ward because of a viral or bacterial meningitis
, in the period from 1997 to September 2005.
Seventy-one children with viral and 21 with bacterial meningitis
were included. Bacterial meningitis
occurred at much younger ages than viral meningitis
. The paediatrician decided to administer antibiotics in 41 of 71 children with viral meningitis
and in all children with bacterial meningitis
. We developed a ‘bacterial meningitis
score’ based on C-reactive protein in peripheral blood
, as well as glucose and protein in cerebrospinal fluid
. Using this score, we could distinguish 54 of 71 patients with viral meningitis
from the group with bacterial meningitis
. When the dispensing of antibiotics was based on this score, only 16 patients with viral meningitis
would receive antibiotics.
We present a bedside bacterial meningitis
score. Using this bacterial meningitis
score as a decision-making tool, we would be able to avoid antibiotics in a large number of children with viral meningitis
. As this gives a 100% success rate, thus guaranteeing that bacterial meningitis
patients would receive the proper therapy, our bacterial meningitis
score could be an accurate decision-support tool.