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April 18, 2007

Prediction Rule for Bacterial Meningitis in Children—Reply

Author Affiliations

Letters Section Editor: Robert M. Golub, MD, Senior Editor.

JAMA. 2007;297(15):1653-1655. doi:10.1001/jama.297.15.1654

In Reply: As Dr Obaro notes, some of the patients included in the aseptic meningitis group in our study did not have blood cultures obtained (although all had negative CSF cultures). Among these patients, 7 had Lyme meningitis, 79 had laboratory diagnosed enteroviral meningitis, and 253 did not have a specific diagnosis. We believe that we were correct in classifying these 253 patients as having aseptic meningitis for several reasons.

Review of the medical records of these patients revealed that none were treated with a standard course of antibiotics for bacterial meningitis (94% received ≤3 days of parenteral antibiotics; none received ≥7 days). All of these patients were discharged with a diagnosis of aseptic meningitis by their attending physicians. Patients without blood cultures obtained (n = 253) were significantly older than patients with blood cultures (n = 3041) (mean age, 9.6 vs 5.0 years; independent sample t test, P<.001). This is likely because of clinician perception of a lower risk of bacteremia in older children. Even with these 253 patients excluded, the performance of the Bacterial Meningitis Score would be essentially identical (sensitivity, 98.3%; 95% confidence interval [CI], 94.2%-99.8%; specificity, 61.4%; 95% CI, 59.5%-63.3%; and negative predictive value, 99.9%; 95% CI, 99.6%-100%).