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Prediction of Neurologic Sequelae in Childhood Tuberculous Meningitis: A Review of 20 Cases and Proposal of a Novel Scoring System

Saitoh, Akihiko MD*; Pong, Alice MD; Waecker, Norman J. Jr MD§; Leake, John A. D. MD, MPH; Nespeca, Mark P. MD; Bradley, John S. MD

The Pediatric Infectious Disease Journal: March 2005 - Volume 24 - Issue 3 - p 207-212
doi: 10.1097/01.inf.0000154321.61866.2d
Original Studies
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Background: Despite effective antituberculous medications, the mortality and morbidity remain high in children with tuberculous meningitis (TBM). The traditional clinical staging for TBM developed by Lincoln et al in 1960 has been widely used to predict long term neurologic sequelae (NS). In the current era of critical care medicine and corticosteroid therapy, a new scoring system is needed to predict NS more accurately in children with TBM.

Methods: We reviewed all available cases of TBM in San Diego, CA, during 1991–2001 retrospectively, and we developed a novel scoring system to predict NS in children with TBM. We assessed a tuberculous meningitis acute neurologic (TBAN) score at day 0 and on day 3 of hospitalization, to compare children who subsequently developed severe NS with those who did not.

Results: Among 20 children with TBM, 7 children developed severe NS and 1 child died during hospitalization. The TBAN score was higher on day 0 in those with severe NS (5.5 versus 2.0, P = 0.09), and the difference became statistically significant by day 3 of hospitalization (5.5 versus 0.0, P = 0.02). Sensitivity and specificity of the TBAN score (≥4) on day 0 (75 and 92%) and day 3 (88 and 100%) to predict severe NS were superior to the traditional clinical staging system on day 0 (63 and 58%).

Conclusions: The TBAN score is an objective marker for predicting severe NS in children with TBM.

From the *Division of Infectious Diseases, Department of Pediatrics, University of California; the Divisions of †Infectious Diseases and ‡Neurology, Children's Hospital and Health Center; and the §Division of Infectious Diseases, Department of Pediatrics, United States Naval Hospital, San Diego, CA

Accepted for publication September 10, 2004.

Supported in part by General Clinical Research Center grant NIH M01 RR00827.

The views expressed in this article are those of the authors and do not reflect the official policy or position of the department of the Navy, Department of Defense, or the United States Government.

Presented in part as a poster presentation (poster 677) at the 40th Meeting of the Infectious Disease Society of America, October 26, 2002, Chicago, IL.

Address for reprints: John S. Bradley, MD, Division of Infectious Diseases, Children's Hospital and Health Center, San Diego, 3020 Children's Way, MC 5041, San Diego, CA 92123. Fax 858-571-3372; E-mail jbradley@chsd.org.

© 2005 Lippincott Williams & Wilkins, Inc.