title: Value of different staging systems for predicting neurological outcome in childhood tuberculous meningitis.
abstract: BACKGROUND
  The stage of tuberculous meningitis (TBM) at presentation is strongly associated with prognosis.
  
  
  OBJECTIVE
  To compare different staging systems for TBM in predicting outcome.
  
  
  METHODS
  The associations of different staging systems with neurological outcome were assessed  using clinical, diagnostic and outcome data of 554 TBM children admitted to Tygerberg Children's Hospital from January 1985 to April 2005.
  
  
  RESULTS
  The refined Medical Research Council (MRC) scale after 1 week (84%, 95%CI 81-88) had the highest discriminatory power in predicting neurological  morbidity. The Glasgow Coma Score (GCS) on admission, GCS after 1 week, the 'refined' MRC scale on admission and Tygerberg Children's Hospital (TCH) staging method all had excellent discriminatory powers in predicting outcome. Improvement of staging after 1 week occurred in children  who did not have signs of raised intracranial pressure (P = 0.004) or brainstem dysfunction on admission (P = 0.030).
  
  
  CONCLUSIONS
  The 'refined' MRC scale 1 week after diagnosis showed the best association with neurological outcome after 6 months of treatment.  The excellent discriminatory power of the TCH scale and its simplicity of use make it the ideal scale for use in resource-poor settings.
authors.affiliation: Department of Paediatrics and Child Health, Tygerberg Children's Hospital, Faculty of Health Sciences, Stellenbosch University, Cape Town, Western Cape, South Africa. vtoorn@sun.ac.za
authors.forename: R
authors.initials: R
authors.lastname: van Toorn
authors.forename: P
authors.initials: P
authors.lastname: Springer
authors.forename: J A
authors.initials: JA
authors.lastname: Laubscher
authors.forename: J F
authors.initials: JF
authors.lastname: Schoeman
mesh_terms: D001933:Brain Stem / Q000473:pathology*; D002648:Child; D015600:Glasgow Coma Scale; D006305:Health Status Indicators; D006776:Hospitals, Pediatric; D006801:Humans; D019586:Intracranial Hypertension / Q000453:epidemiology / Q000209:etiology*; D009422:Nervous System Diseases / Q000209:etiology* / Q000503:physiopathology; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014390:Tuberculosis, Meningeal / Q000150:complications / Q000188:drug therapy / Q000503:physiopathology*