EDUS examination yielded a high negative predictive value and good positive predictive value, allowing rapid discharge and avoiding improper anticoagulant treatment.

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One-third of diplopic patients had secondary diplopia. In patients with isolated diplopia, UHCT does not increase diagnostic sensitivity. In patients with associated neurological signs or symptoms, the prevalence of secondary diplopia was high and UHCT showed incremental diagnostic value.

EDUS examination yielded a high negative predictive value and good positive predictive value, allowing rapid discharge and avoiding improper anticoagulant treatment.

Microbiological tests on cerebrospinal fluid (CSF) utilize a common urgent-care procedure that does not take into account the chemical and cytological characteristics of the CSF, resulting sometimes in an unnecessary use of human and diagnostic resources. The aim of this study was to retrospectively validate a simple scoring system (bacterial meningitis-Careggi score [BM-CASCO]) based on blood and CSF sample chemical/cytological parameters for evaluating the probability of acute bacterial meningitis (ABM) in adults. BM-CASCO (range, 0 to 6) was defined by the following parameters: CSF cell count, CSF protein levels, CSF lactate levels, CSF glucose-to-serum glucose ratio, and peripheral neutrophil count. BM-CASCO was retrospectively calculated for 784 cases of suspected ABM in adult subjects observed during a four-and-a-halfyear-period (2010 to 2014) at the emergency department (ED) of a large tertiary-care teaching hospital in Italy. Among the 28 confirmed ABM cases (3.5%), Streptococcus pneumoniae was the most frequent cause (16 cases). All ABM cases showed a BM-CASCO value of >3. Most negative cases (591/756) exhibited a BM-CASCO value of <1, which was adopted in our laboratory as a cutoff to not proceed with urgent microbiological analysis of CSF in cases of suspected ABM in adults. During a subsequent 1-year follow-up, the introduction of the BM-CASCO in the diagnostic workflow of ABM in adults resulted in a significant decrease in unnecessary microbiological analysis, with no false negatives. In conclusion, BM-CASCO appears to be an accurate and simple scoring system for optimization of the microbiological diagnostic workflow of ABM in adults. C ases of acute bacterial meningitis (ABM) require prompt diagnosis and treatment due to significant mortality rates (1, 2). A delay in starting appropriate therapy may worsen the prognosis (1). Recently, the epidemiology of ABM has shifted to older age groups due to the increasing child vaccination rates against the most common meningeal pathogens (3, 4). Streptococcus pneumoniae is currently the leading cause of ABM in adults and is associated with a 17 to 30% mortality rate (2-4).Diagnosis of ABM at the time of clinical presentation is often difficult and requires laboratory investigation of cerebrospinal fluid (CSF) specimens. A Gram stain of the CSF sediment is a widely used test for the rapid detection of bacteria but may suffer from low sensitivity (5). When evaluated on adult subjects not previously treated with antibiotics, the CSF Gram stain has been reported to have a sensitivity between 60% and 92% (6). Sensitivity can be increased by molecular tests, such as real-time PCR (RT-PCR), but these tests are still not widespread due to their high cost and the need for expensive equipment and experienced laboratory personnel. Bacterial culture remains the gold standard for microbiological diagnosis of ABM, but it requires longer times and suffers from reduced sensitivity in cases involving previous antimicrobial chemotherapy (6). In addition, biochemical and cyto...

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