Diagnostic accuracy of point-of-care cerebrospinal fluid leucocyte esterase dipstick test for bacterial meningitis in the Emergency Department
OBJECTIVE: The primary objective was to evaluate the sensitivity and specificity of cerebrospinal fluid (CSF) leucocyte esterase dipstick test for rapid diagnosis of bacterial meningitis. The secondary objective was to determine the diagnostic accuracy of the combination of CSF leukocyte esterase, e...
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| Format: | Article |
| Language: | English |
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Verduci Editore
2022-10-01
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| Series: | Infectious Diseases and Tropical Medicine |
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| Online Access: | https://www.infectiousjournal.com/wp-content/uploads/sites/6/2022/10/e1028.pdf |
| _version_ | 1797956960711081984 |
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| author | S. Sharda A. Sachdeva C. Ahuja M. Bhatia |
| author_facet | S. Sharda A. Sachdeva C. Ahuja M. Bhatia |
| author_sort | S. Sharda |
| collection | DOAJ |
| description | OBJECTIVE: The primary objective was to evaluate the sensitivity and specificity of cerebrospinal fluid (CSF) leucocyte esterase dipstick test for rapid diagnosis of bacterial meningitis. The secondary objective was to determine the diagnostic accuracy of the combination of CSF leukocyte esterase, elevated protein, and low glucose by a semi-quantitative dipstick test for the diagnosis of bacterial meningitis.
PATIENTS AND METHODS: This prospective diagnostic accuracy study was conducted from January 2021 to December 2021 at the Medical Emergency Department of the Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India. Patients aged 13 years or older with suspected meningitis based on presenting symptoms were eligible for inclusion. CSF leucocyte esterase strip test was the primary index test, and the combination of CSF leukocyte esterase, protein, and glucose using the Combur-10 strip was the secondary index test. We used a composite reference standard comprising neuro-imaging, CSF cell counts/glucose/protein obtained from the laboratory, and CSF gram stain/culture.
RESULTS: 87 patients were included, of which 49 (56.32%) had a final diagnosis of bacterial meningitis based on the results of the composite reference standard. CSF leucocyte esterase had sensitivity of 85.71% (95% CI:72.76-94.06), specificity 42.11% (95% CI:26.31-59.18), positive likelihood ratio (LR+) 1.48 (95% CI:1.10-1.99) and negative likelihood ratio (LR-) 0.34 (95% CI:0.16-0.74) for the diagnosis of bacterial meningitis. The combination of CSF leucocyte esterase, elevated CSF protein and low CSF glucose using dipstick test had sensitivity of 87.76% (95% CI:75.23-95.37), specificity 60.53% (95% CI:43.39-75.96), LR+ 2.22 (95% CI:1.48-3.34) and LR- 0.20 (95% CI:0.09-0.45).
CONCLUSIONS: Point-of-care CSF dipstick test combining leucocyte esterase, protein, and glucose has good sensitivity for triaging patients with suspected bacterial meningitis in the Emergency Department. |
| first_indexed | 2024-04-10T23:57:57Z |
| format | Article |
| id | doaj.art-82b476ccefab4b64a6c3707566ff7806 |
| institution | Directory Open Access Journal |
| issn | 2379-4054 |
| language | English |
| last_indexed | 2024-04-10T23:57:57Z |
| publishDate | 2022-10-01 |
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| series | Infectious Diseases and Tropical Medicine |
| spelling | doaj.art-82b476ccefab4b64a6c3707566ff78062023-01-10T10:28:31ZengVerduci EditoreInfectious Diseases and Tropical Medicine2379-40542022-10-01810.32113/idtm_202210_10281028Diagnostic accuracy of point-of-care cerebrospinal fluid leucocyte esterase dipstick test for bacterial meningitis in the Emergency DepartmentS. Sharda0A. Sachdeva1C. Ahuja2M. Bhatia3Department of Internal Medicine, Postgraduate Institute of Medical Education and Research (P.G.I.M.E.R.), Chandigarh, IndiaDepartment of Internal Medicine, Postgraduate Institute of Medical Education and Research (P.G.I.M.E.R.), Chandigarh, IndiaDepartment of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research (P.G.I.M.E.R.), Chandigarh, IndiaDepartment of Internal Medicine, Postgraduate Institute of Medical Education and Research (P.G.I.M.E.R.), Chandigarh, IndiaOBJECTIVE: The primary objective was to evaluate the sensitivity and specificity of cerebrospinal fluid (CSF) leucocyte esterase dipstick test for rapid diagnosis of bacterial meningitis. The secondary objective was to determine the diagnostic accuracy of the combination of CSF leukocyte esterase, elevated protein, and low glucose by a semi-quantitative dipstick test for the diagnosis of bacterial meningitis. PATIENTS AND METHODS: This prospective diagnostic accuracy study was conducted from January 2021 to December 2021 at the Medical Emergency Department of the Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India. Patients aged 13 years or older with suspected meningitis based on presenting symptoms were eligible for inclusion. CSF leucocyte esterase strip test was the primary index test, and the combination of CSF leukocyte esterase, protein, and glucose using the Combur-10 strip was the secondary index test. We used a composite reference standard comprising neuro-imaging, CSF cell counts/glucose/protein obtained from the laboratory, and CSF gram stain/culture. RESULTS: 87 patients were included, of which 49 (56.32%) had a final diagnosis of bacterial meningitis based on the results of the composite reference standard. CSF leucocyte esterase had sensitivity of 85.71% (95% CI:72.76-94.06), specificity 42.11% (95% CI:26.31-59.18), positive likelihood ratio (LR+) 1.48 (95% CI:1.10-1.99) and negative likelihood ratio (LR-) 0.34 (95% CI:0.16-0.74) for the diagnosis of bacterial meningitis. The combination of CSF leucocyte esterase, elevated CSF protein and low CSF glucose using dipstick test had sensitivity of 87.76% (95% CI:75.23-95.37), specificity 60.53% (95% CI:43.39-75.96), LR+ 2.22 (95% CI:1.48-3.34) and LR- 0.20 (95% CI:0.09-0.45). CONCLUSIONS: Point-of-care CSF dipstick test combining leucocyte esterase, protein, and glucose has good sensitivity for triaging patients with suspected bacterial meningitis in the Emergency Department.https://www.infectiousjournal.com/wp-content/uploads/sites/6/2022/10/e1028.pdfcerebrospinal fluidbacterial meningitisleucocyte esterasepoint-of-care testcombur-10dipstick test |
| spellingShingle | S. Sharda A. Sachdeva C. Ahuja M. Bhatia Diagnostic accuracy of point-of-care cerebrospinal fluid leucocyte esterase dipstick test for bacterial meningitis in the Emergency Department Infectious Diseases and Tropical Medicine cerebrospinal fluid bacterial meningitis leucocyte esterase point-of-care test combur-10 dipstick test |
| title | Diagnostic accuracy of point-of-care cerebrospinal fluid leucocyte esterase dipstick test for bacterial meningitis in the Emergency Department |
| title_full | Diagnostic accuracy of point-of-care cerebrospinal fluid leucocyte esterase dipstick test for bacterial meningitis in the Emergency Department |
| title_fullStr | Diagnostic accuracy of point-of-care cerebrospinal fluid leucocyte esterase dipstick test for bacterial meningitis in the Emergency Department |
| title_full_unstemmed | Diagnostic accuracy of point-of-care cerebrospinal fluid leucocyte esterase dipstick test for bacterial meningitis in the Emergency Department |
| title_short | Diagnostic accuracy of point-of-care cerebrospinal fluid leucocyte esterase dipstick test for bacterial meningitis in the Emergency Department |
| title_sort | diagnostic accuracy of point of care cerebrospinal fluid leucocyte esterase dipstick test for bacterial meningitis in the emergency department |
| topic | cerebrospinal fluid bacterial meningitis leucocyte esterase point-of-care test combur-10 dipstick test |
| url | https://www.infectiousjournal.com/wp-content/uploads/sites/6/2022/10/e1028.pdf |
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