Clinical scoring systems for diagnosing tuberculous meningitis: A systematic review

BACKGROUND: Tuberculous meningitis (TBM) is a severe extrapulmonary complication of tuberculosis. Early diagnosis is crucial in improving patient outcomes, albeit difficult given the non-specific clinical presentation of early stage TBM. Numerical diagnostic scoring systems may be useful diagnostic tools for clinicians, particularly in resource-constrained settings. AIM: To describe existing TBM diagnostic scores with the primary focus being on scores with external validation. METHODS: PubMed and EMBASE were searched from inception to 21 March 2024. Cross-sectional studies with numerical TBM scoring systems were included. Literature pertaining to non-human, non-live subjects, single diagnostic tests, papers with no gold standard diagnosis, and non-English papers were excluded. RESULTS: We reviewed 21 unique scoring systems, of which 4 have been externally validated. Key features of the scores (clinical, laboratory, microbiological, histopathological and radiological criteria, interpretation), outcomes (sensitivity, specificity) and study population (location, demographics, subgroups) were described. CONCLUSION: We suggest Thwaites (2002) and Marais (2010) as first-line TBM screening tests due to high sensitivities and extensive external validation, however clinicians should consider scores specific to their patient population.