{"title":"Critical care in hematopoietic stem cell transplantation: Common complications and management.","authors":"Nishkarsh Gupta, Prateek Maurya, Prakriti Maurya, Anju Gupta","doi":"10.5492/wjccm.v15.i1.113235","DOIUrl":"10.5492/wjccm.v15.i1.113235","url":null,"abstract":"<p><p>This narrative review synthesizes contemporary evidence regarding critical care complications following hematopoietic stem cell transplantation (HSCT) and evaluates management strategies for improving outcomes in this complex population. We conducted a comprehensive literature search of MEDLINE/PubMed databases from January 2014 to December 2024, focusing on critical care complications, prognostic factors, and therapeutic interventions in HSCT recipients. Intensive care unit (ICU) admission affects 8.8%-40% of HSCT recipients, with contemporary 30-day survival reaching 57.7% in specialized centers. Respiratory failure predominates as the primary indication for ICU support. The Lung Injury Prevention Score for Bone Marrow Transplant demonstrates strong predictive accuracy for acute respiratory distress syndrome development. Novel therapeutic approaches show promise, including inhaled tranexamic acid protocols for diffuse alveolar hemorrhage showing promising hemostasis rates in cohort studies, though randomized controlled trial data are lacking. JAK inhibitors achieve improved response rates compared to best available therapy for steroid-refractory graft-versus-host disease (GVHD). The Mount Sinai Acute GVHD International Consortium algorithm provides validated biomarker-based prognostication. Post-transplant cyclophosphamide reduces acute GVHD incidence, while complement inhibition improves outcomes in transplant-associated thrombotic. Early recognition using validated scoring systems and integration of standard ICU protocols with specialized HSCT expertise are essential for optimizing outcomes. Despite advances, significant knowledge gaps remain regarding optimal management strategies for many complications, with most evidence derived from retrospective cohort studies.</p>","PeriodicalId":66959,"journal":{"name":"世界危重病急救学杂志(英文版)","volume":"15 1","pages":"113235"},"PeriodicalIF":0.0,"publicationDate":"2026-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13010842/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147517208","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
世界危重病急救学杂志(英文版)Pub Date : 2026-03-09DOI: 10.5492/wjccm.v15.i1.114318
Jackson Rajendran, Song-Peng Ang, Maria Jose Lorenzo-Capps, Carlos Valladares, Eunseuk Lee, Veera Jayasree Latha Bommu, George Altarcha, Svitlana Pominov, Bryan Gregory, Jia Ee Chia, Jose Iglesias
{"title":"Predicting acute kidney injury in septic shock patients using inflammatory indices in the intensive care unit.","authors":"Jackson Rajendran, Song-Peng Ang, Maria Jose Lorenzo-Capps, Carlos Valladares, Eunseuk Lee, Veera Jayasree Latha Bommu, George Altarcha, Svitlana Pominov, Bryan Gregory, Jia Ee Chia, Jose Iglesias","doi":"10.5492/wjccm.v15.i1.114318","DOIUrl":"10.5492/wjccm.v15.i1.114318","url":null,"abstract":"<p><strong>Background: </strong>Acute kidney injury (AKI) is a prevalent and common complication in critically ill patients with septic shock, associated with increased morbidity, mortality, and healthcare resource utilization in the intensive care unit (ICU). While inflammatory indices derived from standard laboratory tests - such as the neutrophil-to-lymphocyte ratio (NLR), platelet lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), systemic immune-inflammation index (SII), systemic inflammation response index (SIRI), neutrophil percentage to albumin ratio (NPAR) and aggregate index of systemic inflammation (AISI) - have emerged as promising biomarkers for systemic immune activation in critical illness, their direct value as predictors of AKI in large ICU cohorts remains uncertain.</p><p><strong>Aim: </strong>To evaluate the predictive value of inflammatory indices derived from standard laboratory tests as predictors of AKI in ICU patients with septic shock.</p><p><strong>Methods: </strong>This retrospective cohort study utilized the eICU Collaborative Research Database, including adult patients with septic shock admitted to over 200 ICUs across the United States from 2014 to 2015. Patients with pre-existing end-stage renal disease, death within 24 hours, or insufficient data for inflammatory indices were excluded. Inflammatory markers (NLR, PLR, MLR, NPAR, SII, SIRI, AISI) and clinical variables were analyzed. Multivariable logistic regression, principal component analysis, and multilayer perceptron neural network modeling were employed to identify independent predictors of AKI, defined by Kidney Disease Global Outcomes criteria.</p><p><strong>Results: </strong>Among 12660 septic shock patients, 6552 (51.7%) developed AKI during their ICU stay. Patients with AKI were older, had higher body mass index and Sequential Organ Failure Assessment scores, and a greater burden of comorbidities such as chronic kidney disease and diabetes. Univariate analysis showed significantly higher levels of NLR, MLR, SII, NPAR, SIRI, and AISI in the AKI group, suggesting an association between systemic inflammation and kidney injury. However, these indices displayed strong multicollinearity with other clinical and laboratory variables. In logistic regression, traditional predictors such as baseline serum creatinine, blood urea nitrogen, Sequential Organ Failure Assessment score, chronic kidney disease, vasopressor use, and selected comorbidities remained independently associated with AKI, while most individual inflammatory indices did not retain independent significance due to multicollinearity. To address this, principal component analysis employed, which identified three major components - an inflammatory/hematological component, a metabolic/renal/inflammatory component, and an electrolyte/age component. Incorporating these composite dimensions into predictive models significantly improved discrimination for AKI risk. Neural network models further expoun","PeriodicalId":66959,"journal":{"name":"世界危重病急救学杂志(英文版)","volume":"15 1","pages":"114318"},"PeriodicalIF":0.0,"publicationDate":"2026-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13010851/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147517178","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
世界危重病急救学杂志(英文版)Pub Date : 2026-03-09DOI: 10.5492/wjccm.v15.i1.116487
Takahiko Nagamine
{"title":"Neurobiological rhythms in critical care: A commentary on intensive care unit music therapy efficacy and mechanism.","authors":"Takahiko Nagamine","doi":"10.5492/wjccm.v15.i1.116487","DOIUrl":"10.5492/wjccm.v15.i1.116487","url":null,"abstract":"<p><p>This is a commentary on the randomized controlled trial by Mukhtar <i>et al</i>, which reported findings from a single, 30-minute music therapy session administered prior to extubation in mechanically ventilated intensive care unit (ICU) patients. The study found significant acute improvements in psychological distress and physiological stability, alongside an extraordinary, unexpected reduction in ICU length of stay and ICU mortality. These dramatic hard outcomes suggest a mechanism beyond distraction, requiring sustained modulation of the prefrontal cortex-limbic circuit and the substantial upregulation of neuroplasticity markers, specifically brain-derived neurotrophic factor (BDNF). Critically, the molecular changes required for structural reorganization and clinical benefits like reduced mortality necessitate repeated, sustained stimulus, a condition that sharply contrasts with the study's brief protocol. This presents a major mechanistic conundrum. Future research must therefore employ multisession, placebo-controlled, multicenter trials designed to measure objective, sustained neurobiological changes (<i>e.g.</i>, serum BDNF, heart rate variability) to definitively link music therapy to reduced morbidity and mortality in critical care.</p>","PeriodicalId":66959,"journal":{"name":"世界危重病急救学杂志(英文版)","volume":"15 1","pages":"116487"},"PeriodicalIF":0.0,"publicationDate":"2026-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13010572/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147517008","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
世界危重病急救学杂志(英文版)Pub Date : 2026-03-09DOI: 10.5492/wjccm.v15.i1.113515
Syeda Farheen Zaidi, Ajavindu Prasad, Aakash M Gangadhar, Syed A Khan, Amaar H Zaidi, Moisza Mushtaq, Gokhan Anil, Salim Surani
{"title":"Peripartum cardiomyopathy in an intensive care unit setting.","authors":"Syeda Farheen Zaidi, Ajavindu Prasad, Aakash M Gangadhar, Syed A Khan, Amaar H Zaidi, Moisza Mushtaq, Gokhan Anil, Salim Surani","doi":"10.5492/wjccm.v15.i1.113515","DOIUrl":"10.5492/wjccm.v15.i1.113515","url":null,"abstract":"<p><p>Managing pregnant patients in the coronary care unit and the intensive care unit has been a challenge for many clinicians, as they do not encounter those special populations on a routine basis. Peripartum cardiomyopathy (PPCM) is an uncommon but potentially life-threatening condition that occurs during the last month of pregnancy or within five months of delivery. It is associated with left ventricular systolic dysfunction, leading to reduced ejection fraction and heart failure. Although the exact etiology remains unclear, potential contributing factors can include factors such as myocarditis, abnormal immune responses, genetic predispositions, and hormonal imbalances. The future implications of PPCM are wide. Besides physical illness, mental illness can also limit functionality and impose health challenges. Additionally, subsequent pregnancies carry an increased risk of recurrence, especially if cardiac function remains poor. Ongoing research into the molecular and genetic underpinnings of PPCM may pave the way for different targeted therapies and strategies focusing on prevention. Increasing awareness, early detection, and advances in treatment can significantly reduce morbidity and mortality associated with PPCM. Multidisciplinary care is crucial in optimizing outcomes for women affected and their families. This mini review aims to help appraise healthcare providers and clinicians in addressing and managing this challenging condition.</p>","PeriodicalId":66959,"journal":{"name":"世界危重病急救学杂志(英文版)","volume":"15 1","pages":"113515"},"PeriodicalIF":0.0,"publicationDate":"2026-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13010881/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147517050","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
世界危重病急救学杂志(英文版)Pub Date : 2026-03-09DOI: 10.5492/wjccm.v15.i1.113889
Ecaterina Scarlatescu
{"title":"Viscoelastic testing: Transforming hemostasis management in patients in the medical intensive care unit.","authors":"Ecaterina Scarlatescu","doi":"10.5492/wjccm.v15.i1.113889","DOIUrl":"10.5492/wjccm.v15.i1.113889","url":null,"abstract":"<p><p>Viscoelastic testing (VET) has emerged as a groundbreaking method for assessing hemostasis, offering real-time evaluations of coagulation dynamics that exceed traditional tests. It provides immediate insights into the complex interplay among plasma coagulation factors, platelets, and cellular components that regulate hemostatic function, offering a continuous evaluation of the entire hemostatic process - from initial clot formation and stabilization to dissolution. Although often utilized in surgical settings such as liver transplants, trauma, or cardiac surgery, VET has also proven valuable in medical intensive care units (ICUs). In non-surgical patients in the ICU, coagulopathy is common, and timely decision-making is critical. VET offers distinct advantages over conventional coagulation tests by providing rapid, point-of-care results that can guide targeted therapeutic interventions. VET-guided transfusion algorithms have reduced allogeneic transfusion rates by 20%-40%, shortened time to intervention by 30%-50% compared to conventional coagulation tests, and improved ICU length of stay. This review discusses VET's principles, limitations, clinical applications in medical ICUs, and the challenges of its implementation. Incorporating VET into routine clinical practice signifies a shift toward advanced, individualized hemostatic care, significantly enhancing patient safety and clinical outcomes while optimizing resource utilization in modern medical ICUs.</p>","PeriodicalId":66959,"journal":{"name":"世界危重病急救学杂志(英文版)","volume":"15 1","pages":"113889"},"PeriodicalIF":0.0,"publicationDate":"2026-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13010472/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147517205","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
世界危重病急救学杂志(英文版)Pub Date : 2026-03-09DOI: 10.5492/wjccm.v15.i1.110552
Caleb Fisher, Stephen Warrillow
{"title":"Continuous renal replacement therapy in acute liver failure.","authors":"Caleb Fisher, Stephen Warrillow","doi":"10.5492/wjccm.v15.i1.110552","DOIUrl":"10.5492/wjccm.v15.i1.110552","url":null,"abstract":"<p><p>Acute liver failure (ALF) is a devastating condition that primarily affects young adults. This often-lethal condition involves a rapid loss of hepatic function, that then leads to multiple organ failure. The accumulation of numerous toxins, especially ammonia, causes cerebral oedema and intracranial hypertension. Continuous renal replacement therapy (CRRT) is increasingly recognized as having a key role in ammonia removal in ALF and current evidence suggesting that timing of initiation, dose, and duration of therapy may influence survival. In addition to this important role of toxin clearance, CRRT helps with other complications of ALF such as acid-base balance, prevention of fever and management of fluid balance. As such, we propose that CRRT in ALF should be viewed as an \"metabolic-toxin-fluid\" therapy as much as a treatment for renal failure. In this review article we will explore the mechanisms of benefit, indications and evidence to support this concept of CRRT in ALF.</p>","PeriodicalId":66959,"journal":{"name":"世界危重病急救学杂志(英文版)","volume":"15 1","pages":"110552"},"PeriodicalIF":0.0,"publicationDate":"2026-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13010883/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147517176","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
世界危重病急救学杂志(英文版)Pub Date : 2026-03-09DOI: 10.5492/wjccm.v15.i1.112345
Apurva Aggarwal, Mohd Mustahsin, Piyush Shishir
{"title":"Comparison of intubating laryngeal mask airway and video laryngoscope during emergency intubation in patients who are critically ill.","authors":"Apurva Aggarwal, Mohd Mustahsin, Piyush Shishir","doi":"10.5492/wjccm.v15.i1.112345","DOIUrl":"10.5492/wjccm.v15.i1.112345","url":null,"abstract":"<p><strong>Background: </strong>Emergency endotracheal intubation is a high-risk procedure in patients who are critically ill and associated with complications such as hypoxia, hemodynamic instability, and airway trauma. The intubating laryngeal mask airway (ILMA) and video laryngoscope (VL) are alternative devices to conventional direct laryngoscopy, but their comparative efficacy in emergency settings remains understudied.</p><p><strong>Aim: </strong>To compare the first-attempt success rate, intubation time, hemodynamic response, and complications between ILMA and VL in emergency intubations.</p><p><strong>Methods: </strong>A prospective randomized study was conducted on 64 patients who were critically ill and requiring emergency intubation. Patients were divided into the VL (<i>n</i> = 32) and ILMA (<i>n</i> = 32) groups. Primary outcomes included first-attempt success rate and intubation time. Secondary outcomes assessed hemodynamic changes (mean arterial pressure, heart rate, oxygen saturation) and complications (trauma, desaturation, sore throat).</p><p><strong>Results: </strong>The VL group had a significantly higher first-attempt success rate (87.5% <i>vs</i> 53.1%, <i>P</i> = 0.009) and shorter total intubation time (44.0 ± 19.7 seconds <i>vs</i> 82.5 ± 14.5 seconds, <i>P</i> < 0.001). Hemodynamic responses were comparable, but ILMA was associated with more complications (mouth damage: 26.9% <i>vs</i> 0%, <i>P</i> = 0.002; sore throat: 26.9% <i>vs</i> 3.1%, <i>P</i> = 0.009).</p><p><strong>Conclusion: </strong>VL is superior to ILMA for emergency intubation, offering higher first-pass success, faster intubation, and fewer complications. VL should be prioritized in critical care settings.</p>","PeriodicalId":66959,"journal":{"name":"世界危重病急救学杂志(英文版)","volume":"15 1","pages":"112345"},"PeriodicalIF":0.0,"publicationDate":"2026-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13010630/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147517197","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Intracranial pressure management in severe intraventricular hemorrhage: A minireview.","authors":"Wu-Si Qiu, Hao-Dong Chen, Wen-Jie Yang, Ming-Min Chen","doi":"10.5492/wjccm.v15.i1.115169","DOIUrl":"10.5492/wjccm.v15.i1.115169","url":null,"abstract":"<p><p>Severe intraventricular hemorrhage (IVH) is a life-threatening neurological emergency that poses significant risks of morbidity and mortality, particularly due to the associated elevated intracranial pressure (ICP). Studies have shown that the incidence of IVH in very preterm infants is high, with management strategies playing a significant role in its development. Moreover, predictive models have been developed to forecast early mortality and severe IVH in very-low birth weight preterm infants, indicating the complexity and multifactorial nature of this condition. This mini-review synthesizes recent advances in the understanding of intracranial dynamics, monitoring technologies, and therapeutic strategies for managing ICP in IVH. The Monro-Kellie 4.0 framework integrates cerebrovascular autoregulation, intracranial compliance, and glymphatic clearance as core determinants of ICP. Pathophysiological mechanisms include obstructive hydrocephalus, hemoglobin-mediated neurotoxicity, and cortical spreading depolarizations. Advancements in non-invasive monitoring techniques, such as ICP monitoring and genetic testing, coupled with the integration of artificial intelligence, are significantly improving early detection capabilities and enabling more personalized management strategies. Therapeutic advances include algorithmic cerebrospinal fluid drainage, glymphatic-enhanced therapies, and precision hyperosmolar therapy. This review highlights the need for standardized protocols, large-scale trials, and artificial intelligence-driven approaches to improve outcomes in severe IVH.</p>","PeriodicalId":66959,"journal":{"name":"世界危重病急救学杂志(英文版)","volume":"15 1","pages":"115169"},"PeriodicalIF":0.0,"publicationDate":"2026-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13010538/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147516753","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
世界危重病急救学杂志(英文版)Pub Date : 2026-03-09DOI: 10.5492/wjccm.v15.i1.113252
Marco Sanvitti, Laurynas Kanapeckas, Federico Bilotta
{"title":"Minimizing hospital acquired intensive care unit infections: A focus on prevention.","authors":"Marco Sanvitti, Laurynas Kanapeckas, Federico Bilotta","doi":"10.5492/wjccm.v15.i1.113252","DOIUrl":"10.5492/wjccm.v15.i1.113252","url":null,"abstract":"<p><p>Hospital-acquired infections (HAIs) are a leading cause of morbidity and mortality in intensive care units (ICUs), largely driven by invasive devices, immunosuppression, and prolonged hospitalization. Despite available guidelines, prevention strategies remain inconsistently applied across settings. This narrative review synthesized evidence from PubMed (2020-2025) and key guideline documents (World Health Organization, Centers for Disease Control and Prevention, Infectious Diseases Society of America, Society for Healthcare Epidemiology of America), focusing on staff-level, patient-level, and systemic interventions for ICU infection prevention. Eligible sources included systematic reviews, clinical trials, consensus statements, and implementation studies. Effective staff-level strategies include strict hand hygiene, correct use of personal protective equipment, vaccination, and decontamination of personal devices, supported by audits and feedback. Patient-level care bundles targeting ventilator-associated pneumonia, central line-associated bloodstream infection, and catheter-associated urinary tract infection reduce device-related complications, though real-world adherence varies. Systemic measures such as closed ICU models, adequate nurse-to-patient ratios, triage protocols, and single-patient rooms, further mitigate infection risks. Implementation barriers include resource limitations, compliance gaps, and ethical considerations regarding futile care. Preventing ICU-acquired infections requires coordinated, multifaceted strategies embedded into daily practice. Sustained progress depends on leadership, continuous education, auditing, and adaptation of international frameworks to local contexts.</p>","PeriodicalId":66959,"journal":{"name":"世界危重病急救学杂志(英文版)","volume":"15 1","pages":"113252"},"PeriodicalIF":0.0,"publicationDate":"2026-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13010687/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147516774","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
世界危重病急救学杂志(英文版)Pub Date : 2026-03-09DOI: 10.5492/wjccm.v15.i1.110763
Elizabeth Teo, Karon Kung, Sarah Chen, Kay C See
{"title":"Clinical scoring systems for diagnosing tuberculous meningitis: A systematic review.","authors":"Elizabeth Teo, Karon Kung, Sarah Chen, Kay C See","doi":"10.5492/wjccm.v15.i1.110763","DOIUrl":"10.5492/wjccm.v15.i1.110763","url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Aim: </strong>To describe existing TBM diagnostic scores with the primary focus being on scores with external validation.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":66959,"journal":{"name":"世界危重病急救学杂志(英文版)","volume":"15 1","pages":"110763"},"PeriodicalIF":0.0,"publicationDate":"2026-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13010506/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147517203","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}