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Published on: August 16, 2021
Development of clinical-based scoring system to diagnose tuberculous meningitis in children
Setyo Handryastuti1, Dianing Latifah2, Evita Karianni Bermanshah1
1Department of Child Health, Faculty of Medicine, University of Indonesia, Jakarta, Indonesia.
Insights
A new clinical scoring system aids in diagnosing tuberculous meningitis (TBM) in children, especially in resource-limited areas. This tool combines systemic and neurological features for improved TBM prediction.
Area of Science:
- Pediatrics
- Infectious Diseases
- Clinical Diagnostics
Background:
- Diagnosing tuberculous meningitis (TBM) in children is difficult due to slow culture results and limited imaging access in low-resource settings.
- Current diagnostic methods lack sensitivity and timeliness, leading to delayed treatment.
Purpose of the Study:
- To develop and validate a clinical scoring system for diagnosing TBM in pediatric patients.
- To improve TBM diagnosis accuracy using readily available clinical information.
Main Methods:
- A retrospective study utilizing a multivariable prediction model.
- Analysis of clinical manifestations from 167 children hospitalized with meningitis in Indonesia.
- Development of a scoring system based on statistically significant clinical characteristics.
Main Results:
- A scoring system incorporating systemic and neurological features demonstrated good diagnostic performance.
- Systemic features (cut-off ≥3) showed AUC 0.89 (sensitivity 78.8%, specificity 86.6%).
- Combined scoring predicted TBM with 47.1% sensitivity, 95.1% specificity, and 90.9% PPV.
Conclusions:
- A clinical scoring system based on systemic and neurological features can predict TBM in children in resource-limited settings.
- Further assessment in a prospective cohort is recommended to confirm the scoring system's utility.
Objective:
Diagnosing tuberculous meningitis (TBM) in children is challenging due to the low sensitivity with time delay of bacterial culture techniques and the lack of brain imaging facilities in many low- and middle-income settings. This study aims to establish and test a scoring system consisting of clinical manifestations on history and examination for diagnosing TBM in children.
Design:
A retrospective study was conducted using a diagnostic multivariable prediction model.
Participants:
167 children diagnosed with meningitis (tuberculous, bacterial, viral and others) aged 3 months to 18 years who were hospitalised from July 2011 until November 2021 in a national tertiary hospital in Indonesia.
Results:
Eight out of the 10 statistically significant clinical characteristics were used to develop a predictive model. These resulted in good discrimination and calibration variables, which divided into systemic features with a cut-off score of ≥3 (sensitivity 78.8%; specificity 86.6%; the area under the curve (AUC) value 0.89 (95% CI 0.85 to 0.95; p<0.001)) and neurological features with a cut-off score of ≥2 (sensitivity 61.2%; specificity 75.2%; the AUC value 0.73 (95% CI 0.66 to 0.81; p<0.001)). Combined together, this scoring system predicted the diagnosis of TBM with a sensitivity, specificity and positive predictive value of 47.1%, 95.1% and 90.9%, respectively.
Conclusion:
The clinical scoring system consisting of systemic and neurological features can be used to predict the diagnosis of TBM in children with limited resource setting. The scoring system should be assessed in a prospective cohort.
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