Predictors of neurologic deficit on discharge and in-hospital mortality of pediatric tuberculous meningitis patients with hydrocephalus who undergo ventriculoperitoneal shunting

Abstract

Objective: To determine predictors of neurologic deficit on discharge and in-hospital mortality among TBM patients with hydrocephalus who undergo VPS insertion. Methods: This was a retrospective cross-sectional study from January 2005–December 2015. The diagnosis of TBM were based on a combination of clinical features, CSF findings, and neuroimaging appearances. Results: Eighty-three children with TBM who underwent VPS. Their median age was 3 years old, and 61.45% were males. Nearly half of the patients were underweight. A previous and family histories of PTB was reported in 15.66% and 19.28%, respectively. The majority of patients admitted were Stage II (78.31%). More than half had increased CSF protein, and reduced sugar and WBC on analysis. Basilar enhancement in 15.58% and infarction in 3.95% of the patients were noted by neuroimaging. CUS showed rim/halo, increased periventricular echogenicity, and flattened sulci. Duration from onset of symptoms to detection of hydrocephalus was less than two weeks in 26% of Stage II and 41% of Stage III. The duration of altered sensorium prior surgery was less than 24 h for most of the patients across stages. More than half of patients in Stage III with severe hydrocephalus and GCS below 8. The mRS distribution among the Stage II patients; 6.15% normal, 72.31% with neurologic deficit, 10.77% severely debilitated, and 10.77% expired while in Stage III; 47.06% with deficits, 11.76% severely debilitated, and 41.18% expired. Patients whose CSF protein and severe hydrocephalus were poor mRS scores on discharge (95% CI 1.1044 to 7.6062, p = 0.031). Conclusion: TBM affects mainly children less than 5 years of age and is still a serious public health problem. CSF protein and the severity of hydrocephalus are strongly associated with high mortality rate.