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Meningitis decision rule fails to deter hospitalization of very low risk children
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Recent research in Hospital Pediatrics determined that children designated as very low risk using a bacterial meningitis clinical decision rule were still exposed to hospital-related risks and costs for suspected meningitis infection.
“The Bacterial Meningitis Score is a clinical prediction rule used to identify children at very low risk for bacterial meningitis,” Philip A. Hagedorn, MD, of the division of hospital medicine at Cincinnati Children’s Hospital Medical Center and colleagues wrote. “Despite the decreasing incidence of bacterial meningitis in the era of multivalent conjugate pneumococcal and meningococcal vaccines, most children identified in the ED with cerebrospinal fluid pleocytosis are still admitted to the hospital, leading to unnecessary costs and drug exposures.”
Philip A. Hagedorn
The researchers studied 1,049 pediatric patients aged older than 60 days admitted to the center between 2010 and 2013. Patients had suspicion of meningitis and underwent a complete blood cell count and cerebrospinal fluid testing. The investigators examined hospitalization characteristics to determine the safety and value of very low risk admissions. These included exposures to drugs, radiology and patient costs.
Of the 248 participants who tested positive for pleocytosis in cerebrospinal fluid, 26 were identified as very low risk, with bacterial meningitis scores of 0. Twenty of these very low risk patients, however, were hospitalized despite their clinical decision scores.
Chart review of admitted very low risk patients revealed no alternative diagnosis or continuation of care to support hospitalization. Hagedorn, Shah and colleagues wrote that clinical suspicion of viral meningitis was strong in all cases; however, an average of 35 hours of antibiotic therapies continued to carry over from ED presentation. This resulted in unnecessary exposure to medications, radiology, diagnostics and medical errors.
They also stated that these patients incurred additional unnecessary costs linked to admission, with an average hospitalization fee of about $17,550.
“Consistent application of a well-supported clinical prediction rule such as the Bacterial Meningitis Score has the potential to help both physicians and families make well-informed decisions in cases of suspected meningitis, which may reduce needless costs and exposure to risk,” Hagedorn and colleagues wrote. – by David Costill
Disclosure: The researchers report no relevant financial disclosures.
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