Latifah et al reported a scoring system to diagnose tuberculous meningitis in a pediatric patient. The authors are from the University of Indonesia in Jakarta.
Patient selection: 3 months to 18 years in a developing country
Systemic parameters:
(1) prodromal duration in days
(2) systemic symptoms of tuberculosis
(3) contact with a patient with tuberculosis
(4) chest X-ray findings
Systemic Parameter |
Finding |
Points |
prodromal duration |
< 10 days |
0 |
|
>= 10 days |
1 |
systemic symptoms |
consistent with TB |
2 |
|
none or inconsistent |
0 |
contact with TB |
absent |
0 |
|
present |
1 |
chest X-ray findings |
consistent with TB |
1 |
|
not consistent with TB |
0 |
Neurological parameters:
(1) Glasgow Coma Scale
(2) signs of meningeal stimulation/irritation
(3) cranial nerve palsy
(4) hemiparesis
Neurological Parameter |
Finding |
Points |
Glasgow Coma Scale |
13 to 15 |
0 |
|
3 to 12 |
1 |
meningeal signs |
absent |
0 |
|
present |
1 |
cranial nerve palsy |
absent |
0 |
|
present |
2 |
hemiparesis |
absent |
0 |
|
present |
1 |
score for systemic findings =
= SUM(point for all 4 parameters)
score for neurological findings =
= SUM(point for all 4 parameters)
Interpretation:
• miinimum score for each part: 0
• maximum scor for each part: 5
• A systemic score >= 3 AND a neurological score >= 2 is required to identify a child with tuberculous meningitis.
Performance:
• The sensitivity was 0.47, specificity 0.95, and positive predictive value 0.91. The negative predictive value was 0.63, reflecting the poor sensitivity.
• The area under the ROC curve for the systemic score was 0.89 and for the neurologic score was 0.73.
Specialty: Infectious Diseases