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.