ArticleOman medical journal2013
Tuberculous meningitis: a comparison of scoring systems for diagnosis.
Article in Oman medical journal, 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers.
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Who cites it
10 citing papers in PubMed, 33 citations in OpenAlex.
- Article
- Article
- Tuberculostearic acid incorporated predictive model contributes to the clinical diagnosis of tuberculous meningitis.iScience · 2023Article
- Tuberculous Meningitis: Pathogenesis, Immune Responses, Diagnostic Challenges, and the Potential of Biomarker-Based Approaches.Journal of clinical microbiology · 2021Review
- Challenges in the diagnosis of tuberculous meningitis.Journal of clinical tuberculosis and other mycobacterial diseases · 2020Article
- Aseptic meningitis as a manifestation of a mitochondrial disorder.Archives of medical science : AMS · 2018Article
- A New Scoring System for the Differential Diagnosis between Tuberculous Meningitis and Viral Meningitis.Journal of Korean medical science · 2018Article
- Tuberculous Meningitis in Children and Adults: New Insights for an Ancient Foe.Current neurology and neuroscience reports · 2017Review
- Clinical management of tuberculous meningitis: experiences of 42 cases and literature review.Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology · 2014Review
- Pediatric Tubercular Meningitis: A Review.Journal of pediatric neurosciencesReview
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Authors and funding
4 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectivesTuberculous meningitis (TBM) is a major clinical and public health problem, both for diagnosis and management. We compare two established scoring systems, Thwaites and the Lancet consensus scoring system for the diagnosis of TB and compare the clinical outcome in a tertiary care setting.
methodsWe analyzed 306 patients with central nervous system (CNS) infection over a 5-year period and classified them based on the unit's diagnosis, the Thwaites classification as well as the newer Lancet consensus scoring system. Patients with discordant results-reasons for discordance as well as differences in outcome were also analyzed.
resultsAmong the 306 patients, the final diagnosis of the treating physician was TBM in 84.6% (260/306), acute CNS infections in 9.5% (29/306), pyogenic meningitis in 4.2% (13/306) and aseptic meningitis in 1.3% (4/306). Among these 306 patients, 284 (92.8%) were classified as "TBM" by the Thwaites" score and the rest as "Pyogenic". The Lancet score on these patients classified 29 cases (9.5%) as 'Definite-TBM', 43 cases (14.1%) as "Probable-TBM", 186 cases (60.8%) as "Possible-TBM" and the rest as "Non TBM". There was moderate agreement between the unit diagnosis and Thwaites classification (Kappa statistic = 0.53), as well as the Lancet scoring systems. There is only moderate agreement between the Thwaites classification as well as the Lancet scoring systems. It was noted that 32/ 284 (11%) of patients who were classified as TBM by the Thwaites system were classified as "Non TBM" by the Lancet score and 6/258 (2%) of those who were diagnosed as possible, probable or definite TB were classified as Non TB by the Thwaites score. However, patients who had discordant results between these scores were not different from those who had concordant results when treatment was initiated based on expert clinical evaluation in the tertiary care setting.
conclusionThere was only moderate agreement between the Thwaites' score and the Lancet consensus scoring systems. There is need to prospectively evaluate the cost effectiveness of simple but more effective rapid diagnostic alogrithm in the diagnosis of TB, particularly in a setting without CT and MRI facilities.
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