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To evaluate the diagnostic accuracy of these models in a broad population of children suspected of a central nervous system (CNS) infection, we performed external validation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We performed a systematic literature review in Medline to identify articles on the development, refinement or validation of a prediction model for BM, and validated these models in a prospective cohort of children aged 0\u201318 years old suspected of a CNS infection.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Primary and secondary outcome measures<\/jats:title>\n                    <jats:p>We calculated sensitivity, specificity, predictive values, the area under the receiver operating characteristic curve (AUC) and evaluated calibration of the models for diagnosis of BM.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>In total, 23 prediction models were validated in a cohort of 450 patients suspected of a CNS infection included between 2012 and 2015. In 75 patients (17%), the final diagnosis was a CNS infection including 30 with BM (7%). AUCs ranged from 0.69 to 0.94 (median 0.83, interquartile range [IQR] 0.79\u20130.87) overall, from 0.74 to 0.96 (median 0.89, IQR 0.82\u20130.92) in children aged \u226528 days and from 0.58 to 0.91 (median 0.79, IQR 0.75\u20130.82) in neonates.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Prediction models show good to excellent test characteristics for excluding BM in children and can be of help in the diagnostic workup of paediatric patients with a suspected CNS infection, but cannot replace a thorough history, physical examination and ancillary testing.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2023-081172","type":"journal-article","created":{"date-parts":[[2024,8,8]],"date-time":"2024-08-08T03:51:21Z","timestamp":1723089081000},"page":"e081172","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":9,"title":["Diagnostic prediction models for bacterial meningitis in children with a suspected central nervous system infection: a systematic review and prospective validation study"],"prefix":"10.1136","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3519-4015","authenticated-orcid":false,"given":"Nina S","family":"Groeneveld","sequence":"first","affiliation":[{"name":"Department of Neurology, Amsterdam UMC Location AMC, Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Merijn W","family":"Bijlsma","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Amsterdam UMC Location AMC, Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ingeborg E","family":"van Zeggeren","sequence":"additional","affiliation":[{"name":"Department of Neurology, Amsterdam UMC Location AMC, Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steven L","family":"Staal","sequence":"additional","affiliation":[{"name":"Department of Neurology, Amsterdam UMC Location AMC, Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9828-4459","authenticated-orcid":false,"given":"Michael W T","family":"Tanck","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Data Science, Amsterdam UMC\u2014Locatie AMC, Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diederik","family":"van de Beek","sequence":"additional","affiliation":[{"name":"Department of Neurology, Amsterdam UMC Location AMC, Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthijs C","family":"Brouwer","sequence":"additional","affiliation":[{"name":"Department of Neurology, Amsterdam UMC Location AMC, Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2024,8,7]]},"reference":[{"key":"2025121510113489000_14.8.e081172.1","doi-asserted-by":"publisher","DOI":"10.1097\/00006454-199305000-00008"},{"key":"2025121510113489000_14.8.e081172.2","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0265487","article-title":"Outcome of acute bacterial meningitis among children in Kandahar, Afghanistan: A prospective observational cohort study","volume":"17","author":"Rahimi","year":"2022","journal-title":"PLoS One"},{"key":"2025121510113489000_14.8.e081172.3","doi-asserted-by":"publisher","DOI":"10.1016\/S0387-7604(03)00122-0"},{"key":"2025121510113489000_14.8.e081172.4","doi-asserted-by":"publisher","DOI":"10.1016\/s0140-6736(21)00883-7"},{"key":"2025121510113489000_14.8.e081172.5","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1007\/s40272-020-00426-y","article-title":"Optimizing the use of antibiotic agents in the pediatric intensive care unit: A narrative review","volume":"23","author":"Willems","year":"2021","journal-title":"Paediatr Drugs"},{"key":"2025121510113489000_14.8.e081172.6","doi-asserted-by":"publisher","DOI":"10.1016\/j.cmi.2016.01.007"},{"key":"2025121510113489000_14.8.e081172.7","unstructured":"Runde TJ , Anjum F , Hafner JW . 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