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Description

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.


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