Meningitis: a high Glasgow coma scale score increased the chance of complete recovery.

Clinical bottom line (level 1b)

  1. Over half of patients admitted with meningitis were completely healthy after treatment.
  2. Three-quarters of patients with meningitis admitted with a Glasgow coma scale score of more than 12, were completely healthy after treatment.
  3. A quarter of patients with meningitis admitted with a Glasgow coma scale score of between 9 and 12, were completely healthy after treatment.
  4. One eighth of patients with meningitis admitted with a Glasgow coma scale score of less than 8, were completely healthy after treatment.
Schutte and van der Meyden: Journal of Infection 1998; 37: 112-115
Expires October 2003

The study

Prospective cohort study with objective outcomes, not adjusted for confounding factors, not validated in an independent set of patients.

Setting: neurology department of a university, Pretoria

100 patients (aged range 14 to 75 years, ?% male) meningitis (bacterial 33%, TB 24%, cryptococcal 15%, viral 10% or of unknown aetiolog 18%y)
Adequate treatment of the specific type of meningitis was given.

100% followed for until after treatment
Outcomes studied:
  • healthy after treatment no neurological deficits
  • healthy after treatment , with Glasgow coma scale score (GCS) >12 at admission Assessed by: eyes open- spontaneously, 4; to verbal command, 3; to pain, 2; no response, 1; best motor response- obeys, 6; localises, 5; flexion withdrawal, 4; flexion abnormal, 3; extension, 2; no response, 1; best verbal response- oriented, 5; disoriented, 4; inappropriate words, 3; incomprehensible sounds, 2; no response, 1
  • healthy after treatment, with GCS 9 to 12 at admission
  • healthy after treatment, with GCS of = 8

    • The evidence

    outcome time to outcome number of patients/total number %
    (95% CI)
    healthy after treatment until after treatment 56/100 56.0%
    (46.3% to 65.7%)
    healthy after treatment , with Glasgow coma scale score (GCS) >12 at admission until after treatment 49/65 75.4%
    (64.9% to 85.9%)
    healthy after treatment, with GCS 9 to 12 at admission until after treatment 5/19 26.3%
    (6.50% to 46.1%)
    healthy after treatment, with GCS of = 8 until after treatment 2/16 12.5%
    (0% to 28.7%)

    • CSF-protein level at admission predicted the amount of neurological deficits, p= 0.0025.
    • Age, CSF-neutrophil count and CSF-glucose level had no relationship to outcome.

    Comments

    1. Reanalysis of data excluding chronic and viral meningitis suggests patients with acute meningitis (bacterial or unknown origin) with a GCS above 12 have a 96% chance of complete recovery and those with GCS <= 8 only 15%.
    2. Aetiological agents reflect geographic location - may not be applicable with a different range of causative organisms

    Citation

    1. Schutte C-M, and van der Meyden CH: A prospective study of Glasgow Coma Scale (GCS), age, CSF-neutrophil count, and CSF-prtein and glucose levels as prognostic indicators in 100 adult patients with meningitis. Journal of Infection 1998; 37: 112-115
    Contributor: Clare Wotton and Bob Phillips, October 1999
    Reviewer: Luis Ruiz Del Fresno

    Clinical Question.
    Patient meningitis
    Intervention or Exposure high Glasgow coma score and CSF-protein
    Comparison no risks
    Outcome outcome