Bacterial meningitis scoring systems – in search of the Holy Grail

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Dubos et al make a significant contribution by applying a previously proposed bacterial meningitis score (BMS) to a French patient population with adequate numbers of cases of bacterial meningitis to permit assessment of sensitivity. The sensitivity for the BMS was 99.6%, with a narrow confidence interval of 98.9% and 99.8%. Close, but not a perfect score. Performance of the score across patient populations is likely to vary somewhat – related to predominance of pathogen as a consequence of utilization of conjugate vaccines, typical severity of illness at the time of medical attention, and receipt of antibiotics. An additional caveat from this excellent study is that more than one-third of children in whom a BMS score would have been valuable for urgent management were not eligible for its use (because of age <29 days, a variety of other host factors, or cerebrospinal fluid findings).