Does this child have bacterial meningitis? A systematic review of clinical prediction rules for children with suspected bacterial meningitis.

Autor: Kulik DM; Division of Paediatric Emergency Medicine, Hospital for Sick Children, Toronto, Ontario, Canada., Uleryk EM, Maguire JL
Jazyk: angličtina
Zdroj: The Journal of emergency medicine [J Emerg Med] 2013 Oct; Vol. 45 (4), pp. 508-19. Date of Electronic Publication: 2013 Aug 02.
DOI: 10.1016/j.jemermed.2013.03.042
Abstrakt: Background: Acute meningitis is a relatively common phenomenon in children. Identifying which children are most likely to have bacterial meningitis vs. self-limiting aseptic meningitis is important, as these children require investigation and antibiotic treatment.
Objective: Our aim was to systematically identify and review the quality and performance of published clinical prediction rules (CPRs) for children with suspected bacterial meningitis.
Methods: Medline and Embase were searched for CPRs involving children 0-18 years of age with suspected bacterial meningitis, with cerebral spinal fluid (CSF) culture used as the reference diagnostic standard. CPR quality was assessed using 17 previously published items. CPR performance was evaluated using sensitivity, negative likelihood ratio, and the treatment frequency that would result if the rule was used.
Results: Eleven studies involving 6675 children with acute meningitis fulfilled all inclusion criteria and were entered in the study. They all describe the derivation or validation of six unique CPRs. A rigorously developed, high-performing, and well-validated CPR ready for clinical use to guide which children with suspected bacterial meningitis should be hospitalized and treated with intravenous antibiotics and which can be safely discharged home was not identified. Areas for quality improvement for future CPR studies include prospective validation using standardized inclusion criteria, adequate blinding, predictor reproducibility assessment, and meticulous follow-up of outcomes. The Bacterial Meningitis Score had the highest quality and performance and is the best candidate for prospective validation.
Conclusions: Until consistently high methodological quality and diagnostic performance are demonstrated through prospective validation, caution is warranted in the routine clinical use of existing CPRs for children with suspected bacterial meningitis.
(Copyright © 2013 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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