Diagnostic prediction models for bacterial meningitis in children with a suspected central nervous system infection: a systematic review and prospective validation study
Objectives Diagnostic prediction models exist to assess the probability of bacterial meningitis (BM) in paediatric patients with suspected meningitis. To evaluate the diagnostic accuracy of these models in a broad population of children suspected of a central nervous system (CNS) infection, we perfo...
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| Format: | Article |
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BMJ Publishing Group
2024-08-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/14/8/e081172.full |
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| author | Michael W T Tanck Matthijs C Brouwer Diederik van de Beek Merijn W Bijlsma Nina S Groeneveld Ingeborg E van Zeggeren Steven L Staal |
| author_facet | Michael W T Tanck Matthijs C Brouwer Diederik van de Beek Merijn W Bijlsma Nina S Groeneveld Ingeborg E van Zeggeren Steven L Staal |
| author_sort | Michael W T Tanck |
| collection | DOAJ |
| description | Objectives Diagnostic prediction models exist to assess the probability of bacterial meningitis (BM) in paediatric patients with suspected meningitis. To evaluate the diagnostic accuracy of these models in a broad population of children suspected of a central nervous system (CNS) infection, we performed external validation.Methods We performed a systematic literature review in Medline to identify articles on the development, refinement or validation of a prediction model for BM, and validated these models in a prospective cohort of children aged 0–18 years old suspected of a CNS infection.Primary and secondary outcome measures We calculated sensitivity, specificity, predictive values, the area under the receiver operating characteristic curve (AUC) and evaluated calibration of the models for diagnosis of BM.Results In total, 23 prediction models were validated in a cohort of 450 patients suspected of a CNS infection included between 2012 and 2015. In 75 patients (17%), the final diagnosis was a CNS infection including 30 with BM (7%). AUCs ranged from 0.69 to 0.94 (median 0.83, interquartile range [IQR] 0.79–0.87) overall, from 0.74 to 0.96 (median 0.89, IQR 0.82–0.92) in children aged ≥28 days and from 0.58 to 0.91 (median 0.79, IQR 0.75–0.82) in neonates.Conclusions Prediction models show good to excellent test characteristics for excluding BM in children and can be of help in the diagnostic workup of paediatric patients with a suspected CNS infection, but cannot replace a thorough history, physical examination and ancillary testing. |
| format | Article |
| id | doaj-art-d29803df67484c7d9c1f693c02bc337d |
| institution | OA Journals |
| issn | 2044-6055 |
| language | English |
| publishDate | 2024-08-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj-art-d29803df67484c7d9c1f693c02bc337d2025-08-20T02:17:33ZengBMJ Publishing GroupBMJ Open2044-60552024-08-0114810.1136/bmjopen-2023-081172Diagnostic prediction models for bacterial meningitis in children with a suspected central nervous system infection: a systematic review and prospective validation studyMichael W T Tanck0Matthijs C Brouwer1Diederik van de Beek2Merijn W Bijlsma3Nina S Groeneveld4Ingeborg E van Zeggeren5Steven L Staal6Department of Epidemiology and Data Science, Amsterdam UMC—Locatie AMC, Amsterdam, The NetherlandsDepartment of Neurology, Amsterdam UMC Location AMC, Amsterdam, The NetherlandsDepartment of Neurology, Amsterdam UMC Location AMC, Amsterdam, The NetherlandsDepartment of Pediatrics, Amsterdam UMC Location AMC, Amsterdam, The NetherlandsDepartment of Neurology, Amsterdam UMC Location AMC, Amsterdam, The NetherlandsDepartment of Neurology, Amsterdam UMC Location AMC, Amsterdam, The NetherlandsDepartment of Neurology, Amsterdam UMC Location AMC, Amsterdam, The NetherlandsObjectives Diagnostic prediction models exist to assess the probability of bacterial meningitis (BM) in paediatric patients with suspected meningitis. To evaluate the diagnostic accuracy of these models in a broad population of children suspected of a central nervous system (CNS) infection, we performed external validation.Methods We performed a systematic literature review in Medline to identify articles on the development, refinement or validation of a prediction model for BM, and validated these models in a prospective cohort of children aged 0–18 years old suspected of a CNS infection.Primary and secondary outcome measures We calculated sensitivity, specificity, predictive values, the area under the receiver operating characteristic curve (AUC) and evaluated calibration of the models for diagnosis of BM.Results In total, 23 prediction models were validated in a cohort of 450 patients suspected of a CNS infection included between 2012 and 2015. In 75 patients (17%), the final diagnosis was a CNS infection including 30 with BM (7%). AUCs ranged from 0.69 to 0.94 (median 0.83, interquartile range [IQR] 0.79–0.87) overall, from 0.74 to 0.96 (median 0.89, IQR 0.82–0.92) in children aged ≥28 days and from 0.58 to 0.91 (median 0.79, IQR 0.75–0.82) in neonates.Conclusions Prediction models show good to excellent test characteristics for excluding BM in children and can be of help in the diagnostic workup of paediatric patients with a suspected CNS infection, but cannot replace a thorough history, physical examination and ancillary testing.https://bmjopen.bmj.com/content/14/8/e081172.full |
| spellingShingle | Michael W T Tanck Matthijs C Brouwer Diederik van de Beek Merijn W Bijlsma Nina S Groeneveld Ingeborg E van Zeggeren Steven L Staal Diagnostic prediction models for bacterial meningitis in children with a suspected central nervous system infection: a systematic review and prospective validation study BMJ Open |
| title | Diagnostic prediction models for bacterial meningitis in children with a suspected central nervous system infection: a systematic review and prospective validation study |
| title_full | Diagnostic prediction models for bacterial meningitis in children with a suspected central nervous system infection: a systematic review and prospective validation study |
| title_fullStr | Diagnostic prediction models for bacterial meningitis in children with a suspected central nervous system infection: a systematic review and prospective validation study |
| title_full_unstemmed | Diagnostic prediction models for bacterial meningitis in children with a suspected central nervous system infection: a systematic review and prospective validation study |
| title_short | Diagnostic prediction models for bacterial meningitis in children with a suspected central nervous system infection: a systematic review and prospective validation study |
| title_sort | diagnostic prediction models for bacterial meningitis in children with a suspected central nervous system infection a systematic review and prospective validation study |
| url | https://bmjopen.bmj.com/content/14/8/e081172.full |
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