Development and validation of a multivariable predictive model to distinguish bacterial from aseptic meningitis in children in the post-Haemophilus influenzae era

Pediatrics. 2002 Oct;110(4):712-9. doi: 10.1542/peds.110.4.712.


Context: Children with meningitis are routinely admitted to the hospital and administered broad-spectrum antibiotics pending culture results because distinguishing bacterial meningitis from aseptic meningitis is often difficult.

Objective: To develop and validate a simple multivariable model to distinguish bacterial meningitis from aseptic meningitis in children using objective parameters available at the time of patient presentation.

Design: Retrospective cohort study of all children with meningitis admitted to 1 urban children's hospital from July 1992 through June 2000, randomly divided into derivation (66%) and validation sets (34%).

Patients: Six hundred ninety-six previously healthy children aged 29 days to 19 years, of whom 125 (18%) had bacterial meningitis and 571 (82%) had aseptic meningitis.

Intervention: Multivariable logistic regression and recursive partitioning analyses identified the following predictors of bacterial meningitis from the derivation set: Gram stain of cerebrospinal fluid (CSF) showing bacteria, CSF protein > or =80 mg/dL, peripheral absolute neutrophil count > or =10 000 cells/mm3, seizure before or at time of presentation, and CSF absolute neutrophil count > or =1000 cells/mm3. A Bacterial Meningitis Score (BMS) was developed on the derivation set by attributing 2 points for a positive Gram stain and 1 point for each of the other variables.

Main outcome measure: The accuracy of the BMS when applied to the validation set.

Results: A BMS of 0 accurately identified patients with aseptic meningitis without misclassifying any child with bacterial meningitis in the validation set. The negative predictive value of a score of 0 for bacterial meningitis was 100% (95% confidence interval: 97%-100%). A BMS > or =2 predicted bacterial meningitis with a sensitivity of 87% (95% confidence interval: 72%-96%).

Conclusions: The BMS accurately identifies children at low (BMS = 0) or high (BMS > or =2) risk of bacterial meningitis. Outpatient management may be considered for children in the low-risk group.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't
  • Validation Study

MeSH terms

  • Adolescent
  • Adult
  • Bacteria / isolation & purification
  • Cerebrospinal Fluid / microbiology
  • Cerebrospinal Fluid Proteins / analysis
  • Child
  • Child, Preschool
  • Diagnosis, Differential
  • Female
  • Gentian Violet
  • Humans
  • Infant
  • Infant, Newborn
  • Leukocyte Count
  • Logistic Models
  • Male
  • Meningitis, Aseptic / blood
  • Meningitis, Aseptic / cerebrospinal fluid
  • Meningitis, Aseptic / diagnosis*
  • Meningitis, Bacterial / blood
  • Meningitis, Bacterial / cerebrospinal fluid
  • Meningitis, Bacterial / diagnosis*
  • Multivariate Analysis
  • Neutrophils
  • Phenazines
  • Predictive Value of Tests


  • Cerebrospinal Fluid Proteins
  • Gram's stain
  • Phenazines
  • Gentian Violet