Korean J Med.  2008 Sep;75(3):316-321.

Diagnostic validity of weighted diagnostic index scores for tuberculous meningitis in adults

• Jung DS
• Oh YJ
• Kwon KT
• Rhee JY
• Shin SY
• Cheong HS
• Lee NY
• Lee H
• Chung DR
• Peck KR
• Song JH

Abstract

BACKGROUND/AIMS: Tuberculous meningitis is a common, occasionally fatal infectious disease of the central nervous system. We evaluated the diagnostic validity of weighted diagnostic index scores (WDIS), which have been suggested to aid in the diagnosis of adult patients with tuberculous meningitis, on the basis of simple clinical and laboratory findings.
METHODS
The microbiological and clinical data of adult patients with either tuberculous or bacterial meningitis were reviewed retrospectively. Diagnostic validity and WDIS cut-off values were evaluated by receiver operating characteristic (ROC) curve analysis.
RESULTS
A total of 77 cases were included: 47 with tuberculous meningitis and 30 with bacterial meningitis. For the diagnosis of tuberculous meningitis, the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of WDIS suggested by Thwaites (cut-off value of < or =4) were 100, 90, 94 and 100%, respectively. Based on ROC curve analysis (area under ROC curve=0.993), a cut-off value of < or =3 was most appropriate for the diagnosis of tuberculous meningitis. The sensitivity and specificity of WDIS with a cut-off value of < or =3 were 100 and 93.3%, respectively.
CONCLUSIONS
Our study demonstrated that WDIS are highly predictable and acceptable for the early diagnosis of tuberculous meningitis in Korea, based on our analysis of clinical and laboratory findings. A cut-off value of < or =3 showed the best diagnostic validity.

Keyword

Tuberculous meningitis; Diagnostic validity

MeSH Terms

Adult
Central Nervous System
Communicable Diseases
Early Diagnosis
Humans
Korea
Meningitis, Bacterial
Retrospective Studies
ROC Curve
Sensitivity and Specificity
Tuberculosis, Meningeal