• François Dubos, Bartosz Korczowski, Denizmen A Aygun, Alain Martinot, Cristina Prat, Annick Galetto-Lacour, Juan Casado-Flores, Erdal Taskin, Francis Leclerc, Carlos Rodrigo, Alain Gervaix, Sandrine Leroy, Dominique Gendrel, Gérard Bréart, and Martin Chalumeau.
• Department of Pediatric Emergencies and Infectious Diseases, Roger-Salengro Hospital, Centre Hopitalier Universitaire Lille and Lille-2 University, Lille, France.
• Arch Pediatr Adolesc Med. 2008 Dec 1;162(12):1157-63.

ObjectiveTo validate procalcitonin (PCT) level as the best biological marker to distinguish between bacterial and aseptic meningitis in children in the emergency department.DesignSecondary analysis of retrospective multicenter hospital-based cohort studies.SettingSix pediatric emergency or intensive care units of tertiary care centers in 5 European countries.ParticipantsConsecutive children aged 29 days to 18 years with acute meningitis.Main Outcome MeasuresUnivariate analysis and meta-analysis to compare the performance of blood parameters (PCT level, C-reactive protein level, white blood cell count, and neutrophil count) and cerebrospinal fluid parameters (protein level, glucose level, white blood cell count, and neutrophil count) quickly available in the emergency department to distinguish early on between bacterial and aseptic meningitis.ResultsOf 198 patients analyzed, 96 had bacterial meningitis. Sensitivity of cerebrospinal fluid Gram staining was 75%. The PCT level had significantly better results than the other markers for area under the receiver operating characteristic curve (0.98; 95% confidence interval, 0.95-0.99; P = .001). At a 0.5-ng/mL threshold, PCT level had 99% sensitivity (95% confidence interval, 97%-100%) and 83% specificity (95% confidence interval, 76%-90%) for distinguishing between bacterial and aseptic meningitis. The diagnostic odds ratio between high PCT level and bacterial meningitis was 139 (95% confidence interval, 39-498), without significant heterogeneity between centers.ConclusionsThe PCT level is a strong predictor for distinguishing between bacterial and aseptic meningitis in children in the emergency department. Its combination with other parameters in an effective clinical decision rule could be helpful.

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