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Development and Validation of a Multivariable Predictive Model to Distinguish Bacterial From Aseptic Meningitis in Children in the Post-Haemophilus influenzae Era Lise E. Nigrovic, MD*; Nathan Kuppermann, MD, MPH§; and Richard Malley, MD*‡ ABSTRACT. Context. Children with meningitis are ABBREVIATIONS. CSF, cerebrospinal fluid; WBC, white blood routinely admitted to the hospital and administered cell count; Hib, Haemophilus influenzae type b; ANC, absolute broad-spectrum antibiotics pending culture results be- neutrophil count; RBC, red blood cells; ROC, receiver operating cause distinguishing bacterial meningitis from aseptic characteristic; BMS, Bacterial Meningitis Score; NPV, negative pre- meningitis is often difficult. dictive value; CI, confidence interval; PPV, positive predictive Objective. To develop and validate a simple multiva- value. riable model to distinguish bacterial meningitis from aseptic meningitis in children using objective parameters available at the time of patient presentation. acterial meningitis remains an important cause Design. Retrospective cohort study of all children Bof morbidity and mortality in children despite with meningitis admitted to 1 urban children’s hospital the advent of highly effective bacterial conju- from July 1992 through June 2000, randomly divided into gate vaccines. In the United States each year, there derivation (66%) and validation sets (34%). are close to 6000 new cases of bacterial meningitis, of Patients. Six hundred ninety-six previously healthy which approximately half occur in children yo