Abstract
Objective
To derive and validate a risk score for an adverse clinical outcome in adults with
meningitis and a negative cerebrospinal fluid (CSF) Gram stain.
Patients and Methods
We conducted a retrospective study of 567 adults from Houston, Texas, with meningitis
evaluated between January 1, 2005, and January 1, 2010. The patients were divided
into derivation (N=292) and validation (N=275) cohorts. An adverse clinical outcome
was defined as a Glasgow Outcome Scale score of 4 or less.
Results
Of the 567 patients, 62 (11%) had an adverse clinical outcome. A predictive model
was created using 3 baseline variables that were independently associated with an
adverse clinical outcome (P<.05): age greater than 60 years, abnormal findings on neurologic examination (altered
mental status, focal neurologic deficits, or seizures), and CSF glucose level of less
than 2.4975 mmol/L (to convert CSF glucose to mmol/L, multiply by 0.05551). The model
classified patients into 2 categories of risk for an adverse clinical outcome—derivation
sample: low risk, 0.6% and high risk, 32.8%; P<.001; and validation sample: low risk, 0.5% and high risk, 21.1%; P<.001.
Conclusion
Adults with meningitis and a negative CSF Gram stain can be accurately stratified
for the risk of an adverse clinical outcome using clinical variables available at
presentation.
Abbreviations and Acronyms:
ACO (adverse clinical outcome), CMV (cytomegalovirus), CSF (cerebrospinal fluid), ED (emergency department), MRI (magnetic resonance imaging), VZV (varicella zoster virus)To read this article in full you will need to make a payment
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Article Info
Footnotes
Dr Hossain is currently affiliated with Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
Grant Support: This work was supported by grant NIH-1 K23 RR018929-01A2 from the National Center for Research Resources (R.H.); a grant from Grant-A-Starr Foundation (S.H.W.).; and by the Center for Clinical and Translational Sciences at The University of Texas Health Science Center at Houston ( UL1 RR024148 ).
Identification
Copyright
© 2012 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.
ScienceDirect
Access this article on ScienceDirectLinked Article
- Prognostic Risk Score for Pleocytosis With a Negative Gram Stain: Valid but of Limited Utility in Bacterial Meningitis PatientsMayo Clinic ProceedingsVol. 88Issue 4
- PreviewMeningitis with a negative cerebrospinal fluid (CSF) Gram stain has an extensive differential diagnosis including both benign and life-threatening etiologies. Reliable prognostic risk stratification at presentation could aid physicians in management decisions and patient counseling in the emergency department. In the December 2012 issue of Mayo Clinic Proceedings, Khoury et al1 reported on the derivation and validation of a risk score for an adverse clinical outcome in this patient group. Patients were classified as low risk if they had normal neurologic examination findings, had a CSF glucose level of 45 mg/dL or higher, and were 60 years old or younger.
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