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2018 ; 6
(1
): e8
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Accuracy of Neck stiffness, Kernig, Brudzinski, and Jolt Accentuation of Headache
Signs in Early Detection of Meningitis
#MMPMID29503833
Ala A
; Rahmani F
; Abdollahi S
; Parsian Z
Emerg (Tehran)
2018[]; 6
(1
): e8
PMID29503833
show ga
INTRODUCTION: The diagnostic value of clinical signs in early diagnosis of
meningitis has been evaluated but the existing results are contradicting. The
present study aimed to evaluate the accuracy of Kernig, Brudzinski, neck
stiffness, and Jolt Accentuation of Headache (JAH) signs in this regard. METHODS:
In this diagnostic accuracy study, patients with suspected meningitis who were
referred to the emergency department were examined regarding presence or absence
of the mentioned clinical signs and screening performance characteristics of the
signs were calculated. Cerebrospinal fluid analysis was used as the reference
test. RESULTS: 120 cases with mean age of 48.79 ± 21.68 years (18 - 93) were
studied (63.3% male). Diagnosis of meningitis was confirmed for 45 (37.5%) cases.
Neck stiffness (p < 0.001), Kernig (p < 0.001), Brudzinski (p < 0.001), and JAH
(p < 0.001) had significantly higher frequency among patients with meningitis.
The accuracy of neck stiffness, Kernig, Brudzinski, and JAH signs in early
detection of meningitis were 0.676 (95% CI: 0.575-0.776), 0.667 (95% CI:
0.552-0.782), 0.720 (95% CI: 0.619-0.821), 0.749 (95% CI: 0.659-839),
respectively. CONCLUSIONS: It seems that diagnostic value of JAH is higher than
other clinical signs but the accuracy of all signs is in poor to fair range. JAH
had the highest sensitivity and Kernig and Brudzinski had the highest
specificity.