I work in a very large practice of adult and peds EM docs and I teach the
adult guys to always err on the conservative side when they are not sure with the
kids. Clearly Evan is erring on the conservative side. Take heart. This is
one more example where the specialist is criticizing the ER doctor in the area
of his specialty. While he is probably right, it is clear that you thought it
out and made a conscious decision to err on the side of caution.
However, I do have a question for the group. It is very clear in the
literature that you cannot distinguish viral from bacterial based on a left shift in
the CSF. Sergio Stocker in Switzerland points out that a predominance of
mononuclear cells excludes bacterial meningitis.
As we live and die based on studies providing an extremely good negative
predictive value in today's risk averse (risk free) society, excuse my ignorance,
but are there any good studies that basically state that more than a certain
percentage of mononuclear cells provides 100% NPV for bacterial meningitis?
Inova Fairfax Hospital
Falls Church VA
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