Paediatric meningitis in the conjugate vaccine era and a novel clinical decision model to predict bacterial aetiology - 30/04/24
on behalf of the UK-ChiMES and ENCEPH-UK study groups2
Summary |
Objectives |
The aims of this study were to assess aetiology and clinical characteristics in childhood meningitis, and develop clinical decision rules to distinguish bacterial meningitis from other similar clinical syndromes.
Methods |
Children aged <16 years hospitalised with suspected meningitis/encephalitis were included, and prospectively recruited at 31 UK hospitals. Meningitis was defined as identification of bacteria/viruses from cerebrospinal fluid (CSF) and/or a raised CSF white blood cell count. New clinical decision rules were developed to distinguish bacterial from viral meningitis and those of alternative aetiology.
Results |
The cohort included 3002 children (median age 2·4 months); 1101/3002 (36·7%) had meningitis, including 180 bacterial, 423 viral and 280 with no pathogen identified. Enterovirus was the most common pathogen in those aged <6 months and 10–16 years, with Neisseria meningitidis and/or Streptococcus pneumoniae commonest at age 6 months to 9 years. The Bacterial Meningitis Score had a negative predictive value of 95·3%. We developed two clinical decision rules, that could be used either before (sensitivity 82%, specificity 71%) or after lumbar puncture (sensitivity 84%, specificity 93%), to determine risk of bacterial meningitis.
Conclusions |
Bacterial meningitis comprised 6% of children with suspected meningitis/encephalitis. Our clinical decision rules provide potential novel approaches to assist with identifying children with bacterial meningitis.
Funding |
This study was funded by the Meningitis Research Foundation, Pfizer and the NIHR Programme Grants for Applied Research.
Le texte complet de cet article est disponible en PDF.Highlights |
• | First study to describe childhood meningitis in the UK in the conjugate vaccine era. |
• | 37% had meningitis; 26% with aseptic meningitis, and 6% with bacterial meningitis. |
• | Most meningitis cases were caused by enterovirus. |
• | The Bacterial Meningitis Score had a high negative predictive value of 95%. |
• | We developed two clinical decision rules to determine risk of bacterial meningitis. |
Keywords : Meningitis, Children, Cerebrospinal fluid, Diagnostics, Bacteria
Plan
Vol 88 - N° 5
Article 106145- mai 2024 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.
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