Prediction of neurologic sequelae in childhood tuberculous meningitis: a review of 20 cases and proposal of a novel scoring system.
BACKGROUND
Despite effective antituberculous medications, the mortality and morbidity remain high in children with tuberculous meningitis (TBM). The traditional clinical staging for TBM developed by Lincoln et al in 1960 has been widely used to predict long term neurologic sequelae (NS). In the current era of critical care medicine and corticosteroid therapy, a new scoring system is needed to predict NS more accurately in children with TBM.


METHODS
We reviewed all available cases of TBM in San Diego, CA, during 1991-2001 retrospectively, and we developed a novel scoring system to predict NS in children with TBM. We assessed a tuberculous meningitis acute neurologic (TBAN) score at day 0 and on day 3 of hospitalization, to compare children who subsequently developed severe NS with those who did not.


RESULTS
Among 20 children with TBM, 7 children developed severe NS and 1 child died during hospitalization. The TBAN score was higher on day 0 in those with severe NS (5.5 versus 2.0, P = 0.09), and the difference became statistically significant by day 3 of hospitalization (5.5 versus 0.0, P = 0.02). Sensitivity and specificity of the TBAN score (> or =4) on day 0 (75 and 92%) and day 3 (88 and 100%) to predict severe NS were superior to the traditional clinical staging system on day 0 (63 and 58%).


CONCLUSIONS
The TBAN score is an objective marker for predicting severe NS in children with TBM.
Saitoh
Akihiko
A
Division of Infectious Diseases, Department of Pediatrics, University of California, San Diego, CA, USA.
Pong
Alice
A
Waecker
Norman J
NJ
Leake
John A D
JA
Nespeca
Mark P
MP
Bradley
John S
JS
D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D017677:Age Distribution; D000704:Analysis of Variance; D000995:Antitubercular Agents / Q000627:therapeutic use; D002140:California / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007223:Infant; D015278:Intensive Care Units, Pediatric; D016015:Logistic Models; D008297:Male; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification*; D009422:Nervous System Diseases / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology*; D011237:Predictive Value of Tests; D011336:Probability; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D017678:Sex Distribution; D016019:Survival Analysis; D014390:Tuberculosis, Meningeal / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology*; D014505:Urban Population
D000305:Adrenal Cortex Hormones; D000995:Antitubercular Agents