Clinical scoring systems for diagnosing tuberculous meningitis: A systematic review

Area of Science:

• Infectious Diseases
• Neurology
• Public Health

Background:

• Tuberculous meningitis (TBM) is a severe complication of tuberculosis with non-specific early symptoms, complicating diagnosis.
• Accurate and timely diagnosis of TBM is critical for patient outcomes, particularly in resource-limited settings.
• Numerical diagnostic scoring systems offer potential as valuable tools for TBM diagnosis.

Purpose of the Study:

• To systematically review and describe existing numerical scoring systems for diagnosing TBM.
• To prioritize TBM diagnostic scores that have undergone external validation.
• To provide clinicians with an overview of available TBM diagnostic tools.

Main Methods:

• A comprehensive literature search was conducted on PubMed and EMBASE up to March 21, 2024.
• Included were cross-sectional studies featuring numerical TBM scoring systems.
• Exclusion criteria encompassed non-human studies, single diagnostic tests, papers lacking a gold standard, and non-English literature.

Main Results:

• Twenty-one unique TBM scoring systems were identified and reviewed.
• Four of these scoring systems demonstrated external validation.
• Key features, performance metrics (sensitivity, specificity), and study population characteristics were detailed for each score.

Conclusions:

• The Thwaites (2002) and Marais (2010) scoring systems are recommended as initial TBM screening tools due to high sensitivity and robust external validation.
• Clinicians should consider patient population-specific characteristics when selecting a TBM diagnostic score.
• Further research may focus on refining and validating scores for diverse demographic groups and clinical settings.