The assessment and management of tuberculous meningitis (TBM) is often complex, yet no standardised approach exists, and evidence for the clinical care of patients, including those with critical illness, is limited. The roles of proformas and checklists are increasing in medicine; proformas provide a framework for a thorough approach to patient care, whereas checklists offer a priority-based approach that may be applied to deteriorating patients in time-critical situations. We aimed to develop a comprehensive assessment proforma and an accompanying 'priorities' checklist for patients with TBM, with the overriding goal being to improve patient outcomes. The proforma outlines what should be asked, checked, or tested at initial evaluation and daily inpatient review to assist supportive clinical care for patients, with an adapted list for patients in critical care. It is accompanied by a supporting document describing why these points are relevant to TBM. Our priorities checklist offers a useful and easy reminder of important issues to review during a time-critical period of acute patient deterioration. The benefit of these documents to patient outcomes would require investigation; however, we hope they will promote standardisation of patient assessment and care, particularly of critically unwell individuals, in whom morbidity and mortality remains unacceptably high.
Bibliographical noteFunding Information:
Tuberculous Meningitis International Research Consortium Rob E. Aarnoutse; Suzanne T. B. Anderson; Nathan C. Bahr; Nguyen D. Bang; David R. Boulware; Tom Boyles; Lindsey H. M. te Brake; Satish Chandra; Felicia C. Chow; Fiona V. Cresswell; Reinout van Crevel; Angharad G. Davis; Sofiati Dian; Joseph Donovan; Kelly E. Dooley; Anthony Figaji; A. Rizal Ganiem; Ravindra Kumar Garg; Diana M. Gibb; Raph L. Hamers; Nguyen T. T. Hiep; Darma Imran; Akhmad Imron; Sanjay K. Jain; Sunil K. Jain; Byramee Jeejeebhoy; Jayantee Kalita; Rashmi Kumar; Vinod Kumar; Arjan van Laarhoven; Rachel P-J. Lai; Abi Manesh; Suzaan Marais; Vidya Mave; Graeme Meintjes; David B. Meya; Usha K. Misra; Manish Modi; Alvaro A. Ordonez; Nguyen H. Phu; Sunil Pradhan; Kameshwar Prasad; Alize M. Proust; Lalita Ramakrishnan; Ursula Rohlwink; Rovina Ruslami; Johannes F. Schoeman; James A. Seddon; Kusum Sharma; Omar Siddiqi; Regan S. Solomons; Nguyen T. T. Thuong; Guy E. Thwaites; Ronald van Toorn; Elizabeth W. Tucker; Sean A. Wasserman; Robert J. Wilkinson.
© 2020 Donovan J et al.
- Critical care
- Tuberculous meningitis