Predictors of Meningitis in Febrile Infants Aged 3 Months or Younger.
- Author:
Hyang Soon SONG
1
;
Eun Ok KIM
;
Young Taek JANG
Author Information
1. Department of Pediatrics, Presbyterian Medical Center, Jeonju, Korea. godlove@hitel.net
- Publication Type:Original Article
- Keywords:
Fever;
Bacterial meningitis;
C-reactive protein
- MeSH:
Aged;
C-Reactive Protein;
Diagnosis, Differential;
Fever;
Humans;
Infant;
Leukocyte Count;
Meningitis;
Meningitis, Bacterial;
Neutrophils;
Retrospective Studies;
Sensitivity and Specificity
- From:Korean Journal of Pediatric Infectious Diseases
2009;16(1):40-46
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
PURPOSE:The purpose of this study was to identify useful predictors for diagnosing bacterial meningitis and performing CSF studies in febrile infants three months or younger. METHODS:Six hundred and fifty two febrile infants with a rectal temperature > or =38.0 degreesC presented from January 2003 to April 2008 and were retrospectively studied. The total white blood cell count (WBC), band count, absolute neutrophil count (ANC), quantitative C-reactive protein (CRP) and blood cultures were performed on admission. The clinical variables associated with bacterial meningitis were analyzed. RESULTS:In patients with bacterial meningitis, the clinical variables including CRP (P= 0.036), band count (P=0.037), ANC (P=0.036) and age (P=0.001) were significantly different. The area under the receiver-operating characteristic curve was 0.969 for CRP, 0.946 for the band count, 0.765 for the ANC and 0.235 for age. A CRP cutoff point of 8 mg/dL was determined to maximize both the sensitivity and specificity (sensitivity 83%, specificity 95%, likelihood ratio 16.6). A CRP concentration of <7 mg/dL "ruled-out" bacterial meningitis, with a likelihood ratio of 0.17, a posttest probability of <0.1% and negative predictive value 91%. A CRP concentration greater than 9 mg/dL had a much higher likelihood ratio (20.1) than the band count (16.6) and ANC (2.2). CONCLUSION:The CRP concentration was a useful laboratory test for the differential diagnosis of bacterial meningitis among febrile infants three months of age or younger. A CRP concentration of<7 mg/dL effectively ruled out bacterial meningitis; a value > or =9 mg/dL increased the clinical suspicion of bacterial meningitis and the need for CSF evaluation.
