<p><b>INTRODUCTION</b>We performed this study to find clinical features and
laboratory parameters that could facilitate the process of selecting
patients who should receive
lumbar punctures from among those
who present with
headache and
fever.</p><p><b>
METHODS</b>We selected
patients aged ≥ 16 years
who presented to and received
lumbar puncture in the
emergency department of Kangwon National
University Hospital,
South Korea, between 2011 and 2013.
Patients who received
lumbar punctures were divided into two groups - those
who were diagnosed with
viral meningitis and those
who were not. We compared the clinical features and
laboratory data between the two groups. Key indices were then used to develop a scoring system to
diagnose viral meningitis in
patients and identify those
who should receive
lumbar punctures.</p><p><b>RESULTS</b>Among the
patients who were included in the study, 42 had
viral meningitis and 96 did not. The variables of
C-reactive protein level ≤ 1.291 mg/dL,
neck stiffness and
vomiting were assigned 3 points, 2 points and 1 point, respectively, in the scoring system. Overall scores ≥ 4 yielded a positive likelihood ratio of 7.79 (
sensitivity 0.600,
specificity 0.923), while negative likelihood ratio decreased to less than 0.1 (0.072) for overall scores < 3.</p><p><b>CONCLUSION</b>Using the proposed scoring system, we were able to determine the likelihood of
viral meningitis in
patients presenting with
fever and
headache, and to successfully identify those
who should receive
lumbar punctures.</p>