Journals / Çocuk Acil ve Yoğun Bakım Dergisi / 2015 / Cilt: 2 - Sayı: 1
The Effectiveness of Laboratory Tests for Predicting Acute Bacterial Meningitis in Pediatric Emergency Department
- Pages
- 19–24
- DOI
- —
Abstract
Objective: To evaluate the accuracy of laboratory tests in identifying children who had lumbar puncture for suspected bacterial meningitis in the ED. Methods: Retrospective review of the medical records of children with preliminary diagnosis of acute bacterial meningitis and had a lumbar puncture between January 1st, 2008 and December 31st, 2013. All patients presenting to the emergency department (ED) of Izmir Training and Research hospital during the study period. Children who received antibiotics prior to admission to the ED were excluded. The patient population was stratied into three group based on the results of cerebrospinal analysis and culture (CSF); normal, aseptic meningitis, and bacterial meningitis. The results of all laboratory tests were compared between the groups. Results: We enrolled 632 patients. The mean age was 42.2 ± 0.8 month (range 1-210 months) and 387 were males. Normal CSF was noted in 205 patients (32.4%), aseptic meningitis 401 patients (63.4%), and 29 (4.6%) had bacterial meningitis. Children with acute bacterial meningitis had a higher level of procalcitonin and lower levels of CSF glucose than children with aseptic meningitis and children with normal CSF (P<0.05). The sensitivity of serum procalcitonin < 24 ng/ml and CSF glucose < 49 mg/dl were 95% and 51.8%, specificity was 92% and 70.6% respectively. No significant difference was noted between the groups for total white blood cell count, neutrophil count, serum C-reactive protein, CSF leukocytes or protein level (P>0.05). Conclusion: Our study results are limited by the small number of patients with acute bacterial meningitis was small in our study population. However, serum procalcitonin appears to accurately identify the majority of children with acute bacterial meningitis in the ED. CAYD 2015;2(1):19-24
Özet
Amaç: Çocuk acil servisinde akut bakteriyel menenjit ön tanısıyla lomber ponksiyon yapılan çocuklarda laboratuvartetkiklerinin tanıdaki yerinin araştırılması.Yöntemler: 01.01.2008 - 31.12.2013 yılları arasında İzmir Tepecik Eğitim ve Araştırma Hastanesi Çocuk AcilServisi'nde akut bakteriyel menenjit ön tanısıyla lomber ponksiyon yapılan çocukların tıbbi kayıtları geriye dönük olarakincelenmiştir. Başvuru öncesi antibiyotik kullanan olgular çalışma dışı bırakılmıştır. Olgular 3 grup altında toplanmıştır:Normal beyin omurilik sıvısı (BOS), aseptik menenjit ve akut bakteriyel menenjit. Bu üç grubun laboratuvar tetkiklerikarşılaştırılmıştır.Bulgular: Toplam 632 olgu (ortalama yaş: 42,2 ± 0,8 ay; minimum: 1 ay; maksimum: 210 ay; 387 erkek) çalışmayadahil edildi. Toplam 205 olguda (%32,4) normal BOS bulguları, 401 olguda (%63,4) aseptik menenjit ve 29 olguda(%4,6) akut bakteriyel menenjit saptandı. Akut bakteriyel menenjit grubunda serum prokalsitonin düzeyi yüksek ve BOSglikoz düzeyi düşük saptandı (p 0,05).Sonuç: Acil serviste lomber ponksiyon yapılan çocuk olguların çok az bir kısmında akut bakteriyel menenjit saptanmıştır. Serum prokalsitonin ölçümü çocuk acil servisinde akut bakteriyel menenjiti ayırt etmede etkin bir laboratuvar testiolarak öne çıkmıştır. CAYD 2015;2(1):19-24.