Internal Medicine
Online ISSN : 1349-7235
Print ISSN : 0918-2918
ISSN-L : 0918-2918
Identifying Low-risk Patients for Bacterial Meningitis in Adult Patients with Acute Meningitis
Yasuharu TokudaMasahiro KoizumiGerald H. SteinRichard B. Birrer
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2009 Volume 48 Issue 7 Pages 537-543


Objective To derive and validate a clinical prediction model with high sensitivity for differentiating aseptic meningitis (AM) patients from bacterial meningitis (BM) patients.
Methods We developed the model using the derivation cohort in a community rural hospital in Okinawa and assessed its performance using the validation cohort in a metropolitan urban hospital in Tokyo. There were 66 (39.5%) and 5 (17.9%) adult patients with BM among the derivation (n=167) and the validation cohort (n=28), respectively. Recursive partitioning analysis was used to determine the important classification variables and to develop a sensitive model to safely exclude BM.
Results The model produced high- and low-risk groups based on the following: 1) Gram stain, 2) CSF neutrophil percent ≤15%, 3) CSF neutrophil count ≤150 cells/mm3, and, 4) mental status change. Among the derivation cohort, there were 65 patients with BM in the high-risk group (n=76), while only one patient with BM was noted (sensitivity, 99%) in the low-risk group (n=91). Among the validation cohort, there were 5 patients with BM in the high-risk group (n=7), while no patient was classified with BM (sensitivity, 100%) in the low-risk group (n=21).
Conclusion This simple and sensitive model might be useful to safely identify low-risk patients for BM who would not require antibiotic treatment.

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© 2009 by The Japanese Society of Internal Medicine
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