This large multicenter study validates the Bacterial Meningitis Score prediction rule in the era of conjugate pneumococcal vaccine as an accurate decision support tool. The risk of bacterial meningitis is very low (0.1%) in patients with none of the criteria. The Bacterial Meningitis Score may be helpful to guide clinical decision making for the management of children presenting to emergency departments with CSF pleocytosis.

WHAT'S KNOWN ON THIS SUBJECT: The Faces Pain Scale-Revised and Color Analog Scale are self-report pain scales that are commonly used for children in the clinical and research settings. WHAT THIS STUDY ADDS:The Faces Pain Scale-Revised and Color Analog Scale overall demonstrate strong psychometric properties in children 4 to 17 years of age, including within subgroups of age, sex, and ethnicity. Convergent validity, however, is questionable in children ,7 years old. abstract BACKGROUND AND OBJECTIVES: The Faces Pain Scale-Revised (FPS-R) and Color Analog Scale (CAS) are self-report pain scales commonly used in children but insufficiently validated in the emergency department setting. Our objectives were to determine the psychometric properties (convergent validity, discriminative validity, responsivity, and reliability) of the FPS-R and CAS, and to determine whether degree of validity varied based on age, sex, and ethnicity. METHODS:We conducted a prospective, observational study of Englishand Spanish-speaking children ages 4 to 17 years. Children with painful conditions indicated their pain severity on the FPS-R and CAS before and 30 minutes after analgesia. We assessed convergent validity (Pearson correlations, Bland-Altman method), discriminative validity (comparing pain scores in children with pain against those without pain), responsivity (comparing pain scores pre-and postanalgesia), and reliability (Pearson correlations, repeatability coefficient). RESULTS:Of 620 patients analyzed, mean age was 9.2 6 3.8 years, 291 (46.8%) children were girls, 341(55%) were Hispanic, and 313(50.5%) were in the younger age group (,8 years). Pearson correlation was 0.85, with higher correlation in older children and girls. Lower convergent validity was noted in children ,7 years of age. All subgroups based on age, sex, and ethnicity demonstrated discriminative validity and responsivity for both scales. Reliability was acceptable for both the FPS-R and CAS. CONCLUSIONS:The FPS-R and CAS overall demonstrate strong psychometric properties in children ages 4 to 17 years, and between subgroups based on age, sex, and ethnicity. Convergent validity was questionable in children ,7 years old. Pediatrics 2013;132:e971-e979 AUTHORS:

In patients with bacterial meningitis, antibiotic pretreatment is associated with higher cerebrospinal fluid glucose levels and lower cerebrospinal fluid protein levels, although pretreatment does not modify cerebrospinal fluid white blood cell count or absolute neutrophil count results.

For children with mild croup, dexamethasone is an effective treatment that results in consistent and small but important clinical and economic benefits. Although the long-term effects of this treatment are not known, our data support the use of dexamethasone in most, if not all, children with croup.

Brief hospitalization or outpatient management with close follow-up may be considered for infants with UTIs at very low risk of adverse events.