Neurology Book

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Nigrovic Clinical Decision Rule

Aka: Nigrovic Clinical Decision Rule, CSF Interpretation for Predicting Bacterial Meningitis, Bacterial Meningitis Score
  1. See Also
    1. Oostenbrink Clinical Decision Rule for Meningitis
    2. Meningitest
  2. Indications
    1. Meningitis evaluation in children over age 2 months and under age 19 years old
  3. Contraindications: Exclusion Criteria
    1. Neurosurgical history
    2. Immunosuppression
    3. CSF RBC Count >0.1 x10^6/ul (>1000/ul)
    4. Antibiotic use in last 48 hours
    5. Purpura
  4. Criteria (1 point for each)
    1. CSF Gram Stain Positive for organisms
    2. CSF Protein >79 mg/dl
    3. Seizure related to current episode
    4. Peripheral Absolute Neutrophil Count > 10,000 cells/mm3
    5. CSF Absolute Neutrophil Count >1000 cells/mm3
  5. Efficacy
    1. Test Sensitivity: 99%
    2. Test Specificity: 63%
  6. Interpretation
    1. Positive if presence of any of above (1 or more points)
      1. Suggests higher likelihood of Bacterial Meningitis
    2. Negative if all criteria are absent
      1. Suggests very low risk of Bacterial Meningitis (<0.1%)
  7. Resources
    1. MD Calc
      1. https://www.mdcalc.com/bacterial-meningitis-score-children
  8. References
    1. Nigrovic (2002) Pediatrics 110:712-9 [PubMed]

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