El-Wahab et al reported clinical decision rules for evaluating an HIV-positive patient for meningitis. One rule helps to separate meningitis from other neurological conditions. The authors are from Alexandria University and Alexandria Fever Hospital in Alexandria, Egypt.
Patient selection: HIV-positive patient with neurological findings
Parameters:
(1) cryptococcal antigen in blood
(2) HIV clinical stage
(3) neck stiffness
(4) drowsiness
(5) photophobia
(6) confusion
(7) altered mental state or consciousness
(8) jaundice
(9) history of substance abuse
Parameter
Finding
Points
cryptococcal antigen
negative
0
positive
4
HIV stage
AIDS
1
pre-AIDS
0
neck stiffness
no
0
yes
1
drowsiness
no
0
yes
1
photophobia
no
0
yes
1.5
confusion
no
0
yes
2
altered mental state or consciousness
no
0
yes
1
jaundice
no
0
yes
1.5
substance abuse
intravenous drug user
1
other
0
no
0
total score =
= SUM(points for all of the parameters)
Interpretation:
• minimum score: 0
• maximum score: 14
• The cutoff in the exploratory cohort was > 5.3. The cutoff in the confirmatory cohort was > 6.
Performance:
• The area under the ROC curve was 0.87 in the exploratory cohort and 0.71 in the confirmatory cohort.
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