title: Prognostic clinical variables in childhood tuberculous meningitis: an experience from Mumbai, India.
abstract: BACKGROUND
  In India, tuberculous meningitis (TBM) is still a major cause of neurological disabilities and death.
  
  
  OBJECTIVE
  To identify the clinical variables which predict the outcome in childhood TBM.
  
  
  METHODS
  Tertiary teaching hospital.
  
  
  METHODS
  Prospective observational study.
  
  
  METHODS
  Thirty-six clinical variables were analyzed in 123 consecutive children with TBM admitted between May 2000 and August 2003. The outcome was assessed in terms of survival or death. Survival meant that the patient was discharged from hospital having made a complete recovery, or with disability.
  
  
  RESULTS
  Twenty-five (20%) children recovered completely, 70 (57%) survived with disability, and 28 (23%) died. Employing univariate analysis nine variables correlated with survival with disability outcome: presence of tonic motor posturing, cranial nerve palsy, focal neurological deficit, hypertonia, moderate to severe hydrocephalus, cerebral infarction on cranial CT, and requiring shunt surgery, and absence of extracranial tuberculosis and no antituberculous-related hepatotoxicity; two variables correlated with fatal outcome: presence of deep coma (Glasgow coma scale score P = 0.012, d.f. = 1, OR 0.12, 95% CI 0.02-0.62) correlated with survival with disability outcome, and presence of deep coma (P = 0.030, d.f. = 1, OR 0.35, 95% CI 0.14-0.90) with fatal outcome.
  
  
  CONCLUSIONS
  In children with TBM, the presence of hypertonia at admission is an independent predictor of neurological sequelae in survivors, and deep coma is an independent predictor of mortality.
authors: Department of Pediatrics, Lokmanya Tilak Municipal Medical College and General Hospital, Sion, Mumbai, India. karandesunil@yahoo.com
authors: Sunil
authors: S
authors: Karande
authors: Vishal
authors: V
authors: Gupta
authors: Madhuri
authors: M
authors: Kulkarni
authors: Anagha
authors: A
authors: Joshi
mesh_terms: D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007194:India; D007223:Infant; D008297:Male; D009752:Nutritional Status; D011237:Predictive Value of Tests; D011379:Prognosis; D016896:Treatment Outcome; D014390:Tuberculosis, Meningeal / Q000134:cerebrospinal fluid / Q000473:pathology* / Q000628:therapy