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A European Multicenter Case Cohort Study

François Dubos, MD; Bartosz Korczowski, MD; Denizmen A. Aygun, MD; Alain Martinot, MD; Cristina Prat, MD, PhD; Annick Galetto-Lacour, MD; Juan Casado-Flores, MD; Erdal Taskin, MD; Francis Leclerc, MD; Carlos Rodrigo, MD, PhD; Alain Gervaix, MD; Sandrine Leroy, MD, PhD; Dominique Gendrel, MD; Gérard Bréart, MD; Martin Chalumeau, MD, PhD

Arch Pediatr Adolesc Med. 2008;162(12):1157-1163.

Objective  To validate procalcitonin (PCT) level as the best biological marker to distinguish between bacterial and aseptic meningitis in children in the emergency department.

Design  Secondary analysis of retrospective multicenter hospital-based cohort studies.

Setting  Six pediatric emergency or intensive care units of tertiary care centers in 5 European countries.

Participants  Consecutive children aged 29 days to 18 years with acute meningitis.

Main Outcome Measures  Univariate analysis and meta-analysis to compare the performance of blood parameters (PCT level, C-reactive protein level, white blood cell count, and neutrophil count) and cerebrospinal fluid parameters (protein level, glucose level, white blood cell count, and neutrophil count) quickly available in the emergency department to distinguish early on between bacterial and aseptic meningitis.

Results  Of 198 patients analyzed, 96 had bacterial meningitis. Sensitivity of cerebrospinal fluid Gram staining was 75%. The PCT level had significantly better results than the other markers for area under the receiver operating characteristic curve (0.98; 95% confidence interval, 0.95-0.99; P = .001). At a 0.5-ng/mL threshold, PCT level had 99% sensitivity (95% confidence interval, 97%-100%) and 83% specificity (95% confidence interval, 76%-90%) for distinguishing between bacterial and aseptic meningitis. The diagnostic odds ratio between high PCT level and bacterial meningitis was 139 (95% confidence interval, 39-498), without significant heterogeneity between centers.

Conclusions  The PCT level is a strong predictor for distinguishing between bacterial and aseptic meningitis in children in the emergency department. Its combination with other parameters in an effective clinical decision rule could be helpful.

Author Affiliations: Department of Pediatric Emergencies and Infectious Diseases, Roger-Salengro Hospital (Drs Dubos and Martinot) and Pediatric Intensive Care Unit, Jeanne-de-Flandre Hospital (Dr Leclerc), Centre Hopitalier Universitaire Lille and Lille-2 University, Lille, France; Department of Pediatrics, Saint-Vincent-de-Paul Hospital, Assistance Publique–Hopitaux de Paris, Paris Descartes University (Drs Dubos, Leroy, Gendrel, and Chalumeau) and Institut National de la Santé et de la Recherche Médicale Unité 149 (Drs Dubos, Leroy, Bréart, and Chalumeau), Paris, France; Department of Pediatrics, Regional Hospital No. 2, University of Rzeszów, Rzeszów, Poland (Dr Korczowski); Department of Pediatrics, Medical Faculty of Firat University, Elazig, Turkey (Drs Aygun and Taskin); Departments of Microbiology (Dr Prat) and Pediatrics (Dr Rodrigo) and Pediatric Infectious Disease Unit (Dr Rodrigo), Hospital Universitari Germans Trias i Pujol, Universidad Autonoma de Barcelona, Badalona, Spain; Department of Pediatrics, University Hospital of Geneva, Geneva, Switzerland (Drs Galetto-Lacour and Gervaix); and Pediatric Intensive Care Unit, Hospital Universitario del Nino Jesus, Universidad Autonoma de Madrid, Madrid, Spain (Dr Casado-Flores).

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