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Development and Validation of a Prognostic Model and Bedside Score for the Neurological Outcome in Children with Tuberculous Meningitis

Indar Kumar SharawatPediatric Neurology Division, Department of Pediatrics, All India Institute of Medical Sciences, Rishikesh, India;

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Aparna RamachandranDepartment of Neurology, IQRAA International Hospital and Research Centre, Kozhikode, Kerala, India;

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Prateek Kumar PandaPediatric Neurology Division, Department of Pediatrics, All India Institute of Medical Sciences, Rishikesh, India;

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Vinod KumarDepartment of Pediatrics, All India Institute of Medical Sciences, Rishikesh, India;

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Poonam SherwaniDepartment of Radiodiagnosis and Imaging, All India Institute of Medical Sciences, Rishikesh, India

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Nowneet Kumar BhatDepartment of Pediatrics, All India Institute of Medical Sciences, Rishikesh, India;

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ABSTRACT.

Only a few studies have explored prognostic factors for tuberculous meningitis (TBM) in children, and an easily applicable bedside prognostic score for TBM has not been developed yet. We compared the sociodemographic, clinical, radiological, and cerebrospinal fluid parameters in the cohort of 94 TBM cases aged 1 to 18 years, with at least 6 months of completed follow-up and determined the prognostic factors associated with poor functional outcome. We assessed our proposed prognostic model using both discrimination and calibration and subsequently used the bootstrap method to validate the model internally. We finally derived an easily applicable bedside prognostic score by rounding off the regression coefficients to the nearest integers. A total of 39 (41%) and 55 (59%) patients had poor and good functional outcomes, respectively, at the end of 6 months (12 died, 13%). In multivariate analysis, a high baseline Pediatric Cerebral Performance Category (PCPC) score, brain infarction in neuroimaging, tonic motor posturing, younger age, and stage III TBM were independent predictors of poor functional outcomes. The final model showed good discrimination (area under the curve = 88.2%, P < 0.001) and good calibration (Hosmer–Lemeshow test, P = 0.53). Bootstrapping also confirmed the internal validity of this model. The PITAS (PCPC score [P], brain infarction in neuroimaging [I], tonic motor posturing [T], age [A], and stage of TBM [S]) score developed from this model has a score ranging from 0 to 12, with a higher score predicting a higher risk of poor functional outcome. The PITAS score performed better than medical research council staging alone in predicting poor functional outcomes (area under the curve = 87.1% versus 82.3%). Our study’s PITAS score, developed and internally validated, has good sensitivity and specificity in predicting poor functional outcomes in pediatric TBM cases at 6 months.

Author Notes

Address correspondence to Prateek Kumar Panda, Assistant Professor, Pediatric Neurology Division, Department of Pediatrics, All India Institute of Medical Sciences, Virbhadra Road, near Barrage, Rishikesh, India 249203. E-mail: drprateekpanda@gmail.com

Authors’ addresses: Indar Kumar Sharawat, Prateek Kumar Panda, Vinod Kumar, and Nowneet Kumar Bhat, Department of Pediatrics, All India Institute of Medical Sciences—Rishikesh, Rishikesh, India, E-mail: sharawatdrindar@gmail.com, drprateekpanda@gmail.com, vinodmbbs52@gmail.com, and drnmbhat@gmail.com. Aparna Ramachandran, Department of Neurology, IQRAA International Hospital and Research Centre, Kozhikode, Kerala, India, E-mail: aparna1234567@gmail.com. Poonam Sherwani, Radiodiagnosis and Imaging, All India Institute of Medical Sciences—Rishikesh, Rishikesh, India, E-mail: sherwanipoonam@gmail.com.

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