Risk score for identifying adults with CSF pleocytosis and negative CSF Gram stain at low risk for an urgent treatable cause
| Autor: | Christiane M. Hadi, Arie van der Ende, Susan H. Wootton, Lucrecia Salazar, Monir Hossain, Mark A. Beilke, Rodrigo Hasbun, Diederik van de Beek, Merijn W Bijlsma, Matthijs C. Brouwer, Nabil T. Khoury |
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| Přispěvatelé: | Other departments, Neurology, Amsterdam institute for Infection and Immunity, Medical Microbiology and Infection Prevention, Amsterdam Neuroscience |
| Rok vydání: | 2013 |
| Předmět: |
Adult
Male Microbiology (medical) medicine.medical_specialty Adolescent Leukocytosis Sensitivity and Specificity Article law.invention Young Adult 03 medical and health sciences 0302 clinical medicine Cerebrospinal fluid CSF pleocytosis law Internal medicine Gram-Negative Bacteria Ambulatory Care medicine Humans 030212 general & internal medicine Young adult Intensive care medicine Pleocytosis Aged Aged 80 and over 0303 health sciences Framingham Risk Score Diagnostic Tests Routine 030306 microbiology business.industry medicine.disease 3. Good health Infectious Diseases Gram staining Cohort Female Gram-Negative Bacterial Infections business Meningitis |
| Zdroj: | Journal of Infection Journal of infection, 67(2), 102-110. W.B. Saunders Ltd |
| ISSN: | 0163-4453 |
| Popis: | Summary Background We aimed to derive and validate a risk score that identifies adults with cerebrospinal fluid (CSF) pleocytosis and a negative CSF Gram stain at low risk for an urgent treatable cause. Methods Patients with CSF pleocytosis and a negative CSF Gram stain were stratified into a prospective derivation ( n = 193) and a retrospective validation ( n = 567) cohort. Clinically related baseline characteristics were grouped into three composite variables, each independently associated with a set of predefined urgent treatable causes. We subsequently derived a risk score classifying patients into low (0 composite variables present) or high (≥1 composite variables present) risk for an urgent treatable cause. The sensitivity of the risk score was determined in the validation cohort and in a prospective case series of 214 adults with CSF-culture proven bacterial meningitis, CSF pleocytosis and a negative Gram stain. Findings A total of 41 of 193 patients (21%) in the derivation cohort and 71 of 567 (13%) in the validation cohort had an urgent treatable cause. Sensitivity of the dichotomized risk score to detect an urgent treatable cause was 100.0% (95% CI 93.9–100.0%) in the validation cohort and 100.0% (95% CI 97.8–100.0%) in bacterial meningitis patients. Interpretation The risk score can be used to identify adults with CSF pleocytosis and a negative CSF Gram stain at low risk for an urgent treatable cause. |
| Databáze: | OpenAIRE |
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