Screening and diagnosis

Classification and risk stratification

Perioperative care

Quality improvement

Patient education

Nonpharmacologic interventions

Therapeutic procedures

Respiratory support

Follow-up and surveillance

Specific circumstances

Preventative measures

Medical management

Surgical interventions

Inpatient care

Diagnostic procedures

Diagnostic investigations

Insufficient evidence to make a recommendation.

Strongly favor this test or intervention.

The Bacterial Meningitis Score for children is designed to quickly assess the risk of bacterial meningitis by evaluating five key clinical indicators. Each indicator contributes equally, and their presence leads to a numerical score that guides interpretation.

To compute the score, consider these indicators:

- CSF Gram stain positive
- CSF Absolute Neutrophil Count (ANC) at or above 1,000 cells per microliter
- CSF protein level at or above 80 mg/dL (equivalent to 800 mg/L)
- Peripheral blood ANC at or above 10,000 cells per microliter
- Occurrence of a seizure at or prior to presentation

For each indicator present, assign a score of 1. The total score, which ranges from 0 to 5, is the sum of the contributions from these indicators. This table summarizes the scoring:

| Indicator                                        | Condition Met (True) | Score Contribution |
|--------------------------------------------------|----------------------|--------------------|
| CSF Gram stain positive                           | Yes                  | 1                  |
| CSF ANC ≥ 1,000 cells/mcL                         | Yes                  | 1                  |
| CSF protein ≥ 80 mg/dL [800 mg/L]                 | Yes                  | 1                  |
| Peripheral blood ANC ≥ 10,000 cells/mcL           | Yes                  | 1                  |
| Seizure at or prior to presentation               | Yes                  | 1                  |

Interpretation of the total score is straightforward:

- A score of 0 indicates the risk is "very low" for bacterial meningitis.
- A score of 1 or higher suggests the risk is "not very low."

This simple yet effective scoring mechanism assists clinicians by summarizing risk based on the presence of specific clinical conditions, aiding in making timely and informed decisions regarding further evaluation and treatment.

The Bacterial Meningitis Score (BMS) for children is a clinical calculator used to identify pediatric patients (from 29 days to 19 years old) at very low risk of bacterial meningitis. This scoring system is particularly useful in distinguishing bacterial from viral meningitis, which can help guide treatment decisions and potentially avoid unnecessary hospitalization or antibiotic use. The BMS includes five criteria: positive cerebrospinal fluid (CSF) Gram stain, CSF protein ≥80 mg/dL, CSF absolute neutrophil count (ANC) ≥1000 cells/mm³, peripheral blood ANC ≥10,000 cells/mm³, and seizure at or prior to presentation. Each positive criterion increases the likelihood of bacterial meningitis. The BMS should not be used in patients with a ventriculoperitoneal shunt or recent neurosurgery, as these conditions can alter the CSF parameters and potentially lead to a false score.

Bacterial meningitis score for children

The Glasgow Coma Scale (GCS) is a tool used to assess a person's level of consciousness. It evaluates three responses: eye opening, verbal, and motor. Each response is scored based on predefined criteria, and the total GCS score ranges from 3 to 15: 

Eye Opening Response:
- Spontaneously: 4 points
- To verbal command: 3 points
- To pain: 2 points
- No response: 1 point

Verbal Response:
- Oriented: 5 points
- Confused: 4 points
- Inappropriate words: 3 points
- Incomprehensible sounds: 2 points
- No verbal response: 1 point

Motor Response:
- Obeys commands: 6 points
- Purposeful movement to painful stimulus: 5 points
- Withdraws in response to pain: 4 points
- Flexion in response to pain: 3 points
- Extension response in response to pain: 2 points
- No motor response: 1 point

To determine the GCS score, collect the patient's responses across these three categories. Assign the corresponding numerical score for each response, then sum them to get the total score. The total score indicates the level of consciousness:

- A score of 3 suggests deep unconsciousness or severe impairment.
- Scores from 4 to 15 indicate ascending levels of consciousness, with lower scores signifying more serious unconscious states.
- Scores between 13 and 15 indicate full consciousness or only mild impairment.

By organizing the patient responses, converting them to numerical values, summing the totals, and analyzing the score range, one can interpret the patient's state of consciousness based on the GCS.

The Glasgow Coma Scale (GCS) is a clinical calculator used to assess the level of consciousness in patients, particularly those with traumatic brain injury. It is applicable to a wide range of patient populations, including both adults and children, and is used in various clinical settings such as emergency departments, intensive care units, and general wards. 

The GCS evaluates three aspects of a patient's responsiveness: eye opening, verbal response, and motor response. Each aspect is scored separately, and the scores are then summed to give a total GCS score ranging from 3 (indicating deep unconsciousness) to 15 (indicating full consciousness). 

The GCS is a valuable tool for initial and ongoing assessment of a patient's neurological status, and it helps guide treatment decisions and prognostication. It is also widely used in clinical research and for benchmarking the quality of care for patients with brain injury.

There are no specific exclusion criteria for the use of the GCS. However, it may be less accurate or not applicable in patients with certain conditions that can affect consciousness or the ability to respond, such as intoxication, hypothermia, or severe facial trauma. It is also less useful in intubated patients, as their verbal response cannot be assessed.

Glasgow Coma Scale (GCS)

The PECARN rule for febrile infants is a decision aid designed to estimate the risk of serious bacterial infections—specifically urinary tract infections (UTIs), bacteremia, or bacterial meningitis—in infants with fever. It evaluates specific laboratory results to guide clinical decision-making.

Here’s how it works:

The rule considers three laboratory findings:

- Urinalysis: Whether it is positive or not
- Absolute Neutrophil Count (ANC): Whether it exceeds 4,090/mcL
- Serum Procalcitonin: Whether it is greater than 1.71 ng/mL

The results of these tests are categorized as either "Yes" or "No," based on whether they meet each specified condition. The decision rule cross-references these inputs through a straightforward logic:

- **Low Risk**: The tool identifies the infant as having a low risk for UTI, bacteremia, or bacterial meningitis if all of the following criteria are met:
  - Urinalysis is negative (i.e., "No" for Urinalysis Positive)
  - ANC is not greater than 4,090/mcL (i.e., "No" for ANC > 4,090/mcL)
  - Serum Procalcitonin is not over 1.71 ng/mL (i.e., "No" for Serum Procalcitonin > 1.71 ng/mL)

- **Not Low Risk**: If the results do not simultaneously satisfy all the conditions for low risk, the tool concludes that the risk is not low. This means a positive finding in any of these parameters would warrant a higher level of concern for a possible bacterial infection.

This tool aids clinicians in identifying infants who may require further examination and possibly more aggressive management based on these specific laboratory test results.

The Pediatric Emergency Care Applied Research Network (PECARN) rule for febrile infants is a clinical calculator used in the pediatric population, specifically for infants aged 60 days or younger who present with fever. The PECARN rule helps clinicians stratify the risk of serious bacterial infections (SBIs) such as meningitis, bacteremia, and urinary tract infections in febrile infants. It uses a combination of patient history, physical examination, and laboratory findings to determine the risk level. 

The clinical utility of the PECARN rule is to guide decision-making regarding the need for lumbar puncture, hospitalization, and antibiotic treatment in febrile infants. It helps to avoid unnecessary invasive procedures and hospitalizations, thus reducing healthcare costs and potential complications.

The PECARN rule should not be used in infants with obvious source of fever (like otitis media or bronchiolitis), those with a known underlying serious disease (like congenital heart disease or immunodeficiency), or in infants who look seriously ill. It is also not applicable to infants who have been previously treated with antibiotics for the current febrile episode.

Pediatric Emergency Care Applied Research Network rule for febrile infants (PECARN rule)

Acute bacterial meningitis

Patients with cerebral vasculitis

Surveillance for long-term sequelae

Surveillance for long-term sequelae, evaluation

ENT evaluation

Pneumococcal immunization

Antibiotic therapy

Antibiotic therapy, empiric antibiotics

Antibiotic therapy (routes and duration)

Post-exposure prophylaxis

Other adjunctive treatments

Blood cultures

Patients with healthcare-associated ventriculitis and meningitis

Patients with healthcare-associated ventriculitis and meningitis (clinical presentation)

Antiviral therapy

Lumbar puncture

Surveillance for long-term sequelae (management of seizures)

Management of sinus vein thrombosis

Antibiotic therapy, definitive antibiotics

Serum inflammatory markers

Brain imaging

Rehabilitation

Surveillance for long-term sequelae (cochlear implantation)

Patients with healthcare-associated ventriculitis and meningitis (intraventricular antimicrobial therapy)

Adjunctive corticosteroids

Repeat lumbar puncture

Patients with healthcare-associated ventriculitis and meningitis (CSF culture)

Diagnosis

Patients with healthcare-associated ventriculitis and meningitis (CSF analysis)

Setting of care

Cerebrospinal fluid analysis

CSF analysis

Antibiotic therapy, timing

Patients with healthcare-associated ventriculitis and meningitis (antifungal therapy)

Meningococcal and Hib immunization

External ventricular drainage

Patients with healthcare-associated ventriculitis and meningitis (definitive antibiotic therapy, Propionibacterium)

Patients with healthcare-associated ventriculitis and meningitis (definitive antibiotic therapy, Acinetobacter)

Patients with healthcare-associated ventriculitis and meningitis (definitive antibiotic therapy, Staphylococcus)

Patients with healthcare-associated ventriculitis and meningitis (diagnostic imaging)

Neuropsychological evaluation

Monitoring for complications

Intrathecal antibiotics

Management of intracranial pressure

Management of ICP

Patients with healthcare-associated ventriculitis and meningitis (definitive antibiotic therapy, Pseudomonas)

Public health reporting

Patients with cerebrospinal fluid shunt infection

Patients with CSF shunt infection, shunt removal

Patients with healthcare-associated ventriculitis and meningitis (empiric antibiotic therapy)

Patients with CSF shunt infection (evaluation)

Patients with CSF shunt infection (clinical presentation)

Indications for surgery

Patients with CSF shunt infection (antibiotic therapy)

Acute bacterial meningitis

Background

Overview

Guidelines

Key sources