Teo E, Kung K, Chen S, See KC. Clinical scoring systems for diagnosing tuberculous meningitis: A systematic review. World J Crit Care Med 2026; 15(1): 110763 [DOI: 10.5492/wjccm.v15.i1.110763]
Corresponding Author of This Article
Elizabeth Teo, Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore 117597, Singapore. elizabethteomin@gmail.com
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Respiratory System
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Systematic Reviews
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Mar 9, 2026 (publication date) through Mar 3, 2026
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World Journal of Critical Care Medicine
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2220-3141
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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
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Teo E, Kung K, Chen S, See KC. Clinical scoring systems for diagnosing tuberculous meningitis: A systematic review. World J Crit Care Med 2026; 15(1): 110763 [DOI: 10.5492/wjccm.v15.i1.110763]
World J Crit Care Med. Mar 9, 2026; 15(1): 110763 Published online Mar 9, 2026. doi: 10.5492/wjccm.v15.i1.110763
Clinical scoring systems for diagnosing tuberculous meningitis: A systematic review
Elizabeth Teo, Karon Kung, Sarah Chen, Kay C See
Elizabeth Teo, Karon Kung, Sarah Chen, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore
Kay C See, Division of Respiratory and Critical Care Medicine, Department of Medicine, National University Hospital, Singapore 119074, Singapore
Author contributions: Teo E, Kung K, and Chen S contributed to the conceptualization, data collection, analysis and interpretation of results; See KC supervised the project; Teo E, Kung K, Chen S, and See KC contributed to the writing of this manuscript; and all authors read and approved the manuscript.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Corresponding author: Elizabeth Teo, Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore 117597, Singapore. elizabethteomin@gmail.com
Received: June 16, 2025 Revised: August 18, 2025 Accepted: November 25, 2025 Published online: March 9, 2026 Processing time: 258 Days and 15.3 Hours
Abstract
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.
Core Tip: Tuberculous meningitis (TBM) is a severe complication of tuberculosis. Early diagnosis is crucial in improving patient outcomes, albeit difficult given the non-specific signs and symptoms of early TBM. Numerical diagnostic scoring systems may be a useful early diagnostic tool for clinicians, particularly in resource-constrained settings. Of all the scores currently published, we suggest using Thwaites (2002) and Marais (2010) as first line TBM screening tests due to their high sensitivities and extensive external validation. Nevertheless, clinicians are encouraged to select scores in accordance with the patient characteristics of the population of interest.
