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Free Content Value of different staging systems for predicting neurological outcome in childhood tuberculous meningitis

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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.

Keywords: neurological outcome; staging systems; tuberculous meningitis

Document Type: Research Article

DOI: http://dx.doi.org/10.5588/ijtld.11.0648

Affiliations: 1: Department of Paediatrics and Child Health, Tygerberg Children's Hospital, Faculty of Health Sciences, Stellenbosch University, Cape Town, Western Cape, South Africa 2: Biostatistics Unit, Medical Research Council of South Africa, Tygerberg, Cape Town, Western Cape, South Africa

Publication date: May 1, 2012

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  • The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on tuberculosis and lung health world-wide.

    Certain IJTLD articles are selected for translation into French, Spanish, Chinese or Russian. They are available on the Union website

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