Erdem et al reported a severity index for patients with tuberculous meningitis. This can help to identify a patient who may have an unfavorable outcome. The authors are from Haydarpasa Training Hospital in Istanbul and multiple institutions in Europe and the Middle East.
Patient selection: tuberculous meningitis
Outcome: permanent sequelae (motor deficit, cranial nerve palsy, ataxia, reduced level of consciuosness or coma, seizures, difficulty with speech, hydrocephalus, diabetes insipidus, anal sphincter dysfunction) or death
Parameters:
(1) level of consciousness plus nausea and vomiting (N+V)
(2) diabetes mellitus
(3) immunosuppression
(4) neurologic deficit (cranial nerve palsy and/or motor neuron deficit)
(5) hydrocephalus
(6) vasculitis
Parameter
Finding
Points
level of consciousness
normal
0
altered with N+V
2
altered without N+V
3
diabetes mellitus
absent
0
present
3
immunosuppression
absent
0
present
2
neurologic deficit
absent
0
present
1
hydrocephalus
absent
0
present
1
vasculitis
absent
0
present
1
total score =
= SUM(points for all of the parameters)
Interpretation:
• minimum score: 0
• maximum score: 11
• The higher the score the more severe the meningitis.
Total Score
Unfavorable Outcome
0 or 1
9%
2
20%
3
38%
4
54%
5
61%
>= 6
74%
Performance:
• The ROC curve is shown is Figure 1.
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