Kumar et al developed a diagnostic rule for identifying children with possible tuberculous meningitis in a developing country with a high prevelance of tuberculosis. This can help identify those patients who should have additional testing performed and for whom antituberculous therapy may be indicated. The authors are from King George's Medical College in Lucknow, India.
Patient selection: children from 1 month to 12 years of age
Parameters:
(1) duration of prodromal stage in days
(2) fundic eye examination
(3) neurologic deficit
(4) movements
(5) CSF white cell differential count
|
Parameter |
Finding |
Points |
|
duration of prodrome |
< 7 days |
0 |
|
|
>= 7 days |
1 |
|
fundic eye examination |
optic nerve atrophy absent |
0 |
|
|
optic nerve atrophy present |
1 |
|
neurologic deficit |
no focal defect |
0 |
|
|
focal deficit present |
1 |
|
movements |
no extrapyramidal movements present |
0 |
|
|
extrapyramidal movements present |
1 |
|
CSF white cell differential count |
>= 50% neutrophils |
0 |
|
|
< 50% neutrophils |
1 |
where:
• The distribution of neurologic clinical findings was ascribed to the frequency of a basilar meningitis with involvement of the cranial nerves and brain stem.
rule score =
= SUM(points for all 5 parameters)
Interpretation:
• minimum score: 0
• maximum score: 5
• The higher the score the more likely the person was to have tuberculous meningitis.
|
Total Score in Validation Group |
Sensitivity |
Specificity |
|
>= 1 |
98.4% |
43.5% |
|
>= 2 |
77.2% |
87% |
|
>= 3 |
54.4% |
98.3% |
Performance:
• A ROC curve analysis in Figure 1 (page 223) showed that the best cutoff score was >= 2.
Specialty: Infectious Diseases, Neurology
