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.
