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Arch Pediatr Adolesc Med. 2002;156:1195-1198.

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

IN THIS issue of the ARCHIVES, Oostenbrink et al^1-2 revisit a prior study of children with meningeal signs who came to the emergency department at Sophia Children's Hospital in Rotterdam, the Netherlands, between 1988 and 1998. In the earlier study,² the authors developed a prediction rule that identified 35% of patients with meningeal signs who did not require lumbar puncture. The study described in this issue seeks to extend that rule by incorporating cerebrospinal fluid (CSF) results with clinical findings to identify children from whom empiric antibiotic therapy can safely be withheld. It combines both a training set and a validation set from the earlier study to use as a new training set. The final rule is a clinical/blood laboratory test score detailed in the article's "Methods" section combined with a CSF variable score best described in its footnote to Table 3 ; the treatment category can be found in . . . [Full Text of this Article]

UTILITY AS A DIAGNOSTIC TEST: ARE THE RESULTS OF THE STUDY VALID?

Was There an Independent, Blind Comparison With a Reference Standard?

Did the Sample Include an Appropriate Spectrum of Patients to Whom the Diagnostic Test Will Be Applied in Clinical Practice?

Did the Results of the Test Influence the Decision to Perform the Reference Standard?

Were the Methods for Performing the Test Described in Sufficient Detail to Permit Replication?

Are Likelihood Ratios for the Test Results Presented, or Are Data Necessary for Their Calculation Included?

Will the Reproducibility of the Test Result and Its Interpretation Be Satisfactory in My Setting?

Are the Results Applicable to My Patient?

CLINICAL DECISION RULES: METHODOLOGICAL STANDARDS FOR DERIVATION AND VALIDATION
Were All of the Important Predictors Included in the Derivation Process?

Were All of the Important Predictors Present in a Significant Proportion of the Study Population?

Were All of the Outcome Events and Predictors Clearly Defined?

Were Those Assessing the Outcome Event Blinded to the Presence of the Predictors, and Those Assessing the Presence of Predictors Blinded to the Outcome Event?

Was the Sample Size Adequate?

Does the Rule Make Clinical Sense?

Has the Rule Been Validated Effectively?

Will the Results Change My Treatment?

Will Patients Be Better Off as a Result of the Test?

CONCLUSIONS


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RELATED ARTICLE

Children With Meningeal Signs: Predicting Who Needs Empiric Antibiotic Treatment
Rianne Oostenbrink, Karel G. M. Moons, Minke J. Twijnstra, Diederick E. Grobbee, and Henriette A. Moll
Arch Pediatr Adolesc Med. 2002;156(12):1189-1194.
ABSTRACT | FULL TEXT