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Still A Challenge

Arch Pediatr Adolesc Med. 2001;155:1307-1310.

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

THIS STUDY¹ explored the usefulness of various characteristics of cerebrospinal fluid (CSF) in making a diagnosis of bacterial meningitis, looking specifically at a period during which most children have been immunized against Haemophilus influenzae type b. In this retrospective study, the authors analyzed the CSF examination results from 1617 children who underwent a lumbar puncture to diagnose community-acquired meningitis. There were 44 cases of definite or presumed meningitis. Of these, 11 had fewer than 30 white blood cells (WBCs) per microliter. Using this value as a cutoff, they calculate likelihood ratios (LRs) for a positive and negative test of 10.3 and 0.27, respectively. They also found that other significant predictors of bacterial meningitis were age, CSF glucose, CSF protein, Gram stain, CSF–serum glucose ratio, and peripheral blood band count. They conclude that children older than 6 months with a CSF WBC count of less than 30/µL (without other abnormal CSF . . . [Full Text of this Article]

VALIDITY OF THE STUDY

Was There an Independent, Blind Comparison With a Reference ("Gold") Standard?

Was the Test Evaluated in an Appropriate Spectrum of Patients?

Was the Gold Standard Applied Regardless of the Diagnostic Test Results?

DETERMINING THE TEST'S IMPORTANCE
Are LRs for the Test Presented or the Data Necessary for Their Calculation Included?

APPLYING THE DIAGNOSTIC TEST TO OUR PATIENTS
Is the Diagnostic Test Available, Affordable, Accurate, and Precise in Our Setting?

Can We Generate a Clinically Sensible Estimate of Our Patient's Pretest Probability?

Will the Resulting Posttest Probabilities Affect Our Management and Help Our Patients?

BENEFITS VS COSTS

CONCLUSION


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RELATED ARTICLE

Predictors of Bacterial Meningitis in the Era After Haemophilus influenzae
Stephen B. Freedman, Angela Marrocco, Jonathan Pirie, and Paul T. Dick
Arch Pediatr Adolesc Med. 2001;155(12):1301-1306.
ABSTRACT | FULL TEXT