{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T22:08:40Z","timestamp":1785881320090,"version":"3.56.0"},"reference-count":24,"publisher":"American Academy of Pediatrics (AAP)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2013,4,1]]},"abstract":"<jats:sec><jats:title>OBJECTIVE:<\/jats:title><jats:p>To determine trends in the diagnosis and management of children with viral meningitis at US children\u2019s hospitals.<\/jats:p><\/jats:sec><jats:sec><jats:title>METHODS:<\/jats:title><jats:p>We performed a multicenter cross sectional study of children presenting to the emergency department (ED) across the 41 pediatric tertiary-care hospitals participating in the Pediatric Health Information System between January 1, 2005, and December 31, 2011. A case of viral meningitis was defined by International Classification of Diseases, Ninth Revision, discharge diagnosis, and required performance of a lumbar puncture. We examined trends in diagnosis, antibiotic use, and resource utilization for children with viral meningitis over the study period.<\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS:<\/jats:title><jats:p>We identified 7618 children with viral meningitis (0.05% of ED visits during the study period). Fifty-two percent of patients were &amp;lt;1 year of age, and 43% were female. The absolute number and the proportion of ED visits for children with viral meningitis declined from 0.98 cases per 1000 ED visits in 2005 to 0.25 cases in 2011 (P &amp;lt; .001). Most children with viral meningitis received a parenteral antibiotic (85%), and were hospitalized (91%). Overall costs for children for children with viral meningitis remain substantial (median cost per case $5056, interquartile range $3572\u2013$7141).<\/jats:p><\/jats:sec><jats:sec><jats:title>CONCLUSIONS:<\/jats:title><jats:p>Between 2005 and 2011, viral meningitis diagnoses at US children\u2019s hospitals declined. However, most of these children are hospitalized, and the cost for caring for these children remains considerable.<\/jats:p><\/jats:sec>","DOI":"10.1542\/peds.2012-3077","type":"journal-article","created":{"date-parts":[[2013,3,26]],"date-time":"2013-03-26T02:07:46Z","timestamp":1364263666000},"page":"670-676","source":"Crossref","is-referenced-by-count":37,"title":["Trends in the Management of Viral Meningitis at United States Children\u2019s Hospitals"],"prefix":"10.1542","volume":"131","author":[{"given":"Lise E.","family":"Nigrovic","sequence":"first","affiliation":[{"name":"Division of Emergency Medicine, Department of Medicine, Boston Children\u2019s Hospital and Harvard Medical School, Boston, Massachusetts; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew M.","family":"Fine","sequence":"additional","affiliation":[{"name":"Division of Emergency Medicine, Department of Medicine, Boston Children\u2019s Hospital and Harvard Medical School, Boston, Massachusetts; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael C.","family":"Monuteaux","sequence":"additional","affiliation":[{"name":"Division of Emergency Medicine, Department of Medicine, Boston Children\u2019s Hospital and Harvard Medical School, Boston, Massachusetts; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samir S.","family":"Shah","sequence":"additional","affiliation":[{"name":"Divisions of Hospital Medicine and Infectious Diseases, Cincinnati Children\u2019s Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark I.","family":"Neuman","sequence":"additional","affiliation":[{"name":"Division of Emergency Medicine, Department of Medicine, Boston Children\u2019s Hospital and Harvard Medical School, Boston, Massachusetts; and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"417","published-online":{"date-parts":[[2013,4,1]]},"reference":[{"issue":"3","key":"2021120903275653600_B1","doi-asserted-by":"crossref","first-page":"244","DOI":"10.1056\/NEJMoa0800836","article-title":"Effect of pneumococcal conjugate vaccine on pneumococcal meningitis.","volume":"360","author":"Hsu","year":"2009","journal-title":"N Engl J Med"},{"issue":"21","key":"2021120903275653600_B2","doi-asserted-by":"crossref","first-page":"2016","DOI":"10.1056\/NEJMoa1005384","article-title":"Bacterial meningitis in the United States, 1998\u20132007.","volume":"364","author":"Thigpen","year":"2011","journal-title":"N Engl J Med"},{"issue":"3","key":"2021120903275653600_B3","doi-asserted-by":"crossref","first-page":"285","DOI":"10.1586\/erv.10.3","article-title":"The epidemiology of meningococcal disease and the impact of vaccines.","volume":"9","author":"Khatami","year":"2010","journal-title":"Expert Rev Vaccines"},{"issue":"4","key":"2021120903275653600_B4","doi-asserted-by":"crossref","first-page":"712","DOI":"10.1542\/peds.110.4.712","article-title":"Development and validation of a multivariable predictive model to distinguish bacterial from aseptic meningitis in children in the post-Haemophilus influenzae era.","volume":"110","author":"Nigrovic","year":"2002","journal-title":"Pediatrics"},{"issue":"1","key":"2021120903275653600_B5","doi-asserted-by":"crossref","first-page":"52","DOI":"10.1001\/jama.297.1.52","article-title":"Clinical prediction rule for identifying children with cerebrospinal fluid pleocytosis at very low risk of bacterial meningitis.","volume":"297","author":"Nigrovic","year":"2007","journal-title":"JAMA"},{"key":"2021120903275653600_B6","volume-title":"Meningitis-Related Hospitalizations in the United States, 2006: Statistical Brief #57. Healthcare Cost and Utilization Project (HCUP)","author":"Holmquist","year":"2006"},{"issue":"6","key":"2021120903275653600_B7","doi-asserted-by":"crossref","first-page":"632","DOI":"10.1111\/j.1553-2712.2012.01377.x","article-title":"U.S. emergency department visits for meningitis, 1993\u20132008.","volume":"19","author":"Takhar","year":"2012","journal-title":"Acad Emerg Med"},{"issue":"11","key":"2021120903275653600_B8","doi-asserted-by":"crossref","first-page":"1664","DOI":"10.1086\/587897","article-title":"Changing epidemiology of pneumococcal meningitis after the introduction of pneumococcal conjugate vaccine in the United States.","volume":"46","author":"Tsai","year":"2008","journal-title":"Clin Infect Dis"},{"issue":"6","key":"2021120903275653600_B9","doi-asserted-by":"crossref","first-page":"E99","DOI":"10.1542\/peds.107.6.e99","article-title":"Deaths attributed to pediatric complex chronic conditions: national trends and implications for supportive care services.","volume":"107","author":"Feudtner","year":"2001","journal-title":"Pediatrics"},{"key":"2021120903275653600_B10","unstructured":"US Food and Drug Administration. National Drug Code Directory. 2012, Available at: www.accessdata.fda.gov\/scripts\/cder\/ndc\/default.cfm. Accessed July 31 2012"},{"issue":"4","key":"2021120903275653600_B11","doi-asserted-by":"crossref","first-page":"287","DOI":"10.1002\/jhm.949","article-title":"Differences in designations of observation care in US freestanding children\u2019s hospitals: are they virtual or real?","volume":"7","author":"Macy","year":"2012","journal-title":"J Hosp Med"},{"issue":"7","key":"2021120903275653600_B12","doi-asserted-by":"crossref","first-page":"530","DOI":"10.1002\/jhm.1923","article-title":"Pediatric observation status: are we overlooking a growing population in children\u2019s hospitals?","volume":"7","author":"Macy","year":"2012","journal-title":"J Hosp Med"},{"key":"2021120903275653600_B13","unstructured":"Bureau of Labor Statistics. Consumer Price Index. 2012. Available at: www.bls.gov\/cpi\/#tables. Accessed September 24, 2012"},{"key":"2021120903275653600_B14","doi-asserted-by":"crossref","first-page":"68","DOI":"10.1186\/1471-2334-6-68","article-title":"Paediatric Investigators Collaborative Network on Infections in Canada (PICNIC) study of aseptic meningitis.","volume":"6","author":"Lee","year":"2006","journal-title":"BMC Infect Dis"},{"issue":"2","key":"2021120903275653600_B15","doi-asserted-by":"crossref","first-page":"814","DOI":"10.1128\/JCM.38.2.814-817.2000","article-title":"Rapid identification of bacteria in blood cultures by using fluorescently labeled oligonucleotide probes.","volume":"38","author":"Jansen","year":"2000","journal-title":"J Clin Microbiol"},{"issue":"7","key":"2021120903275653600_B16","doi-asserted-by":"crossref","first-page":"3390","DOI":"10.1128\/JCM.43.7.3390-3397.2005","article-title":"Rapid diagnosis of bacterial meningitis by real-time PCR and fluorescence in situ hybridization.","volume":"43","author":"Poppert","year":"2005","journal-title":"J Clin Microbiol"},{"issue":"9","key":"2021120903275653600_B17","doi-asserted-by":"crossref","first-page":"799","DOI":"10.1136\/archdischild-2012-301798","article-title":"Meta-analysis of bacterial meningitis score validation studies.","volume":"97","author":"Nigrovic","year":"2012","journal-title":"Arch Dis Child"},{"issue":"4","key":"2021120903275653600_B18","doi-asserted-by":"crossref","first-page":"283","DOI":"10.1097\/00006454-200204000-00005","article-title":"Impact of rapid polymerase chain reaction results on management of pediatric patients with enteroviral meningitis.","volume":"21","author":"Robinson","year":"2002","journal-title":"Pediatr Infect Dis J"},{"issue":"12","key":"2021120903275653600_B19","doi-asserted-by":"crossref","first-page":"1107","DOI":"10.1097\/INF.0b013e31822cca1f","article-title":"Rapid enterovirus molecular testing in cerebrospinal fluid reduces length of hospitalization and duration of antibiotic therapy in children with aseptic meningitis.","volume":"30","author":"Huizing","year":"2011","journal-title":"Pediatr Infect Dis J"},{"issue":"3","key":"2021120903275653600_B20","doi-asserted-by":"crossref","first-page":"489","DOI":"10.1542\/peds.2007-0252","article-title":"Routine cerebrospinal fluid enterovirus polymerase chain reaction testing reduces hospitalization and antibiotic use for infants 90 days of age or younger.","volume":"120","author":"King","year":"2007","journal-title":"Pediatrics"},{"issue":"10","key":"2021120903275653600_B21","doi-asserted-by":"crossref","first-page":"1221","DOI":"10.1086\/656919","article-title":"Low risk of bacterial meningitis in children with a positive enteroviral polymerase chain reaction test result.","volume":"51","author":"Nigrovic","year":"2010","journal-title":"Clin Infect Dis"},{"issue":"7","key":"2021120903275653600_B22","doi-asserted-by":"crossref","first-page":"767","DOI":"10.1197\/j.aem.2006.02.009","article-title":"Lumbar puncture ordering and results in the pediatric population: a promising data source for surveillance systems.","volume":"13","author":"Kimia","year":"2006","journal-title":"Acad Emerg Med"},{"issue":"5","key":"2021120903275653600_B23","doi-asserted-by":"crossref","first-page":"1169","DOI":"10.1542\/peds.108.5.1169","article-title":"Lumbar puncture in pediatric bacterial meningitis: defining the time interval for recovery of cerebrospinal fluid pathogens after parenteral antibiotic pretreatment.","volume":"108","author":"Kanegaye","year":"2001","journal-title":"Pediatrics"},{"issue":"4","key":"2021120903275653600_B24","doi-asserted-by":"crossref","first-page":"726","DOI":"10.1542\/peds.2007-3275","article-title":"Effect of antibiotic pretreatment on cerebrospinal fluid profiles of children with bacterial meningitis.","volume":"122","author":"Nigrovic","year":"2008","journal-title":"Pediatrics"}],"container-title":["Pediatrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/131\/4\/670\/1100547\/peds_2012-3077.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/131\/4\/670\/1100547\/peds_2012-3077.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,2,12]],"date-time":"2022-02-12T10:51:34Z","timestamp":1644663094000},"score":1,"resource":{"primary":{"URL":"https:\/\/publications.aap.org\/pediatrics\/article\/131\/4\/670\/31936\/Trends-in-the-Management-of-Viral-Meningitis-at"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2013,4,1]]},"references-count":24,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2013,4,1]]},"published-print":{"date-parts":[[2013,4,1]]}},"URL":"https:\/\/doi.org\/10.1542\/peds.2012-3077","relation":{},"ISSN":["0031-4005","1098-4275"],"issn-type":[{"value":"0031-4005","type":"print"},{"value":"1098-4275","type":"electronic"}],"subject":[],"published":{"date-parts":[[2013,4,1]]}}}