OBJECTIVE: The primary objective was to evaluate the sensitivity and specificity of cerebrospinal fluid (CSF) leucocyte esterase dipstick test for rapid diagnosis of bacterial meningitis. The secondary objective was to determine the diagnostic accuracy of the combination of CSF leukocyte esterase, elevated protein, and low glucose by a semi-quantitative dipstick test for the diagnosis of bacterial meningitis.

PATIENTS AND METHODS: This prospective diagnostic accuracy study was conducted from January 2021 to December 2021 at the Medical Emergency Department of the Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India. Patients aged 13 years or older with suspected meningitis based on presenting symptoms were eligible for inclusion. CSF leucocyte esterase strip test was the primary index test, and the combination of CSF leukocyte esterase, protein, and glucose using the Combur-10 strip was the secondary index test. We used a composite reference standard comprising neuro-imaging, CSF cell counts/glucose/protein obtained from the laboratory, and CSF gram stain/culture.

RESULTS: 87 patients were included, of which 49 (56.32%) had a final diagnosis of bacterial meningitis based on the results of the composite reference standard. CSF leucocyte esterase had sensitivity of 85.71% (95% CI:72.76-94.06), specificity 42.11% (95% CI:26.31-59.18), positive likelihood ratio (LR+) 1.48 (95% CI:1.10-1.99) and negative likelihood ratio (LR-) 0.34 (95% CI:0.16-0.74) for the diagnosis of bacterial meningitis. The combination of CSF leucocyte esterase, elevated CSF protein and low CSF glucose using dipstick test had sensitivity of 87.76% (95% CI:75.23-95.37), specificity 60.53% (95% CI:43.39-75.96), LR+ 2.22 (95% CI:1.48-3.34) and LR- 0.20 (95% CI:0.09-0.45).

CONCLUSIONS: Point-of-care CSF dipstick test combining leucocyte esterase, protein, and glucose has good sensitivity for triaging patients with suspected bacterial meningitis in the Emergency Department.