Patients admitted under one medical unit of a tertiary level university teaching hospital with approximately 40,000 outpatients (OP) and 2000 inpatients (IP) per year were eligible for inclusion. The present study evaluates the profile of patients with a diagnosis of CNS infections attending a tertiary care centre in India with a focus on TBM and compares the diagnosis made by the treating team with that of the Thwaites and the Lancet scoring systems. CT and MRI tests were used only when there was suspected neurological defecit. Our medical unit diagnosis of TBM is made on a combination of clinical features and CSF findings (largely based on the Thwaites criteria), though finally decided by the treating consultant. 4 The scoring systems include clinical features, CSF findings, as well as neurological imaging in making a diagnosis. Two commonly used methods -Thwaites' system, 3 and more recently, the Lancet consensus scoring system have been developed to improve the diagnostic accuracy. The poor sensitivity of cerebrospinal fluid (CSF) culture in diagnosis of pyogenic, 2 and TBM is one of the major challenges in the diagnostic workup, hence many patients are treated empirically with antibiotics by care givers even before coming to a hospital leading to confusion with the entity "partially treated pyogenic meningitis". The case fatality is noted to be associated significantly with delay in diagnosis, treatment and HIV infection. Despite anti-TB chemotherapy, 20-50% of the affected people die and many who survive have significant neurological deficits. In spite of advances in diagnostic technology and effective therapeutic options, it continues to pose significant management challenges. 1 Among CNS tuberculosis, tuberculous meningitis (TBM) remains the most common presentation. Keywords: Tuberculosis Meningitis Scoring systems Thwaites score Lancet Consensus score Agreement.Ĭentral nervous system (CNS) tuberculosis is one of the more serious manifestation of extra pulmonary TB constituting 6% of all TB cases. 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. 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.Ĭonclusion: There was only moderate agreement between the Thwaites' score and the Lancet consensus 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. There is only moderate agreement between the Thwaites classification as well as the Lancet scoring systems.
There was moderate agreement between the unit diagnosis and Thwaites classification (Kappa statistic = 0.53), as well as the Lancet scoring systems. 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". Among these 306 patients, 284 (92.8%) were classified as "TBM" by the Thwaites" score and the rest as "Pyogenic". Results: Among 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).
Patients with discordant results-reasons for discordance as well as differences in outcome were also analyzed. Methods: We 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. 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. Objectives: Tuberculous meningitis (TBM) is a major clinical and public health problem, both for diagnosis and management. Tuberculous Meningitis: A Comparison of Scoring Systems for Diagnosis. Kurien R, Sudarsanam TD, Samantha S, Thomas K. Tuberculous Meningitis: A Comparison of Scoring Systems for Diagnosis. Oman Med J 2013 May 28(3):163-166.
*Address correspondence and reprints request to: Thambu David Sudarsanam, Medicine Unit 2, Christian Medical College, Vellore, TN India. Medicine Unit 2, Christian Medical College, Vellore, TN India. Roshan Kurien, Thambu David Sudarsanam,* Samantha S, Kurien Thomas Tuberculous Meningitis: A Comparison of Scoring Systems for Diagnosis
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