Moreover, seizures were noted as the most significant diagnostic factor for the diagnosis of Streptococcus pneumoniae (Figure 1).
Overall, age<1 year and absence of haemorrhagic rash were noted as the most significant diagnostic factors for the diagnosis of 'other pathogens'.
In an attempt collectively summarize the diagnostic criteria that have been analysed in this study, it is possible to schematically present a simplified diagram where the most significant diagnostic factors are exploited to enable a possible predetermination of the specific causative bacterial pathogen in suspected meningitis cases upon initial presentation.
Furthermore, the paper explores the use of palliative services and identifies the most significant clinical diagnostic and demographic factors which determine physical and psychological burden.
Adapted from Croskerry [23] unless cited otherwise Satisfaction of search Perhaps the most significant cause of diagnostic error, once a diagnostic finding is met with, the search stops, with the potential of missing a second finding which might be even more significant than the first.
The most significant group of diagnostic criteria for the diagnosis of Meningococcal meningitis included haemorrhagic rash, absence of seizures, headache and negative gram stain with a PPV 96.4%.
Overall from our study, it is apparent that the presence of haemorrhagic rash on presentation is by far the most positively statistically significant diagnostic factor for the diagnosis of Neisseria meningitidis.
For the diagnosis of Meningococcal Meningitis, the most significant group of diagnostic criteria identified included haemorrhagic rash (OR 22.36), absence of seizures (OR 2.51), headache (OR 1.83) and negative gram stain result (OR 1.55) with a Positive Predictive Value (PPV) of 96.4% (95%CI 87.7 99.6).
For the diagnosis of Haemophilus influenzae, the most significant group of diagnostic criteria included, absence of haemorrhagic rash (OR 13.61), age≥1year (OR 2.04), absence of headache (OR 3.01), CSF Glu<40 mg/dL (OR 3.62) and peripheral WBC<15000/µL (OR 1.74) with a PPV of 58.5% (95%CI 42.1 73.7).
For the diagnosis of Streptococcus pneumoniae, the most significant group of diagnostic criteria identified included absence of haemorrhagic rash (OR 13.62), positive gram stain (OR 2.10), coma (OR 3.11), seizures (OR 3.81) and peripheral WBC≥15000/µL (OR 2.19) with a PPV of 77.8% (95%CI 40.0 97.2).
This remains one of the most significant challenges faced by diagnostic and treating physicians today.
