• Logo
  • SBMUJournals

Diagnostic Value of Jolt Accentuation of Headache for Diagnosis of Meningitis in Patients Referred to Emergency Department

Alireza Ala, Farzad Rahmani, Sima Abdollahi, Zahra Parsian
234

Views

PDF

Abstract

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.


Keywords

Meningitis; physical examination; headache disorders, secondary; neurologic manifestations

References

Meurer WJ. Central Nervous System infections. In: Walls MH, editor. Rosen’s Emergency Medicine, Cocenpts and Clinical Practice. 8 ed. Sanders: Elsevier Inc 2014. p. 1447-59.

Fitch MT, Beek D. Emergency diagnosis and treatment of adult meningitis. Lancet Infect Dis. 2007;7:191-200.

Waghhare S, Kalantri A, Joshi R, Kalantri S. Accuracy of physical signs for detecting meningitis: A hospital based diagnostic accuracy study. Clinical Neurology and Neurosurgery. 2010;112:752-7.

Durand ML, Calderwood SB, Weber DJ, Miller SI, Southwick FS, Caviness VS Jr, et al. Acute bacterial meningitis in adults: a review of 493 episodes. N Engl J Med. 1993;328:21-8.

Quagliarello VJ, Scheld WM. Treatment of bacterial meningitis. N Engl J Med 1997;336:708-16.

Tamune H, Takeya H, Suzuki W, Tagashira Y, Kuki T, Nakamura M. Absence of jolt accentuation of headache cannot accurately rule out meningitis in adults. Am J Emerg Med. 2010;31:1601-4.

Uchihara T, Tsukagoshi H. Jolt accentuation of headache: the most sensitive sign of CSF pleocytosis. Headache. 1991;31:167-71.

Rahmani F, Ala A, Morteza Bagi HR. Accuracy of Jolt Accentuation of Headache in Patients with Suspected Meningitis. Emergency Med 2014;4(4).

Ward MA, Greenwood TM, Kumar DR, Mazza JJ, Yale SH. Josef Brudzinski and Vladimir Mikhailovich Kernig: signs for diagnosing meningitis. Clinical medicine & research. 2010;8(1):13-7.

Thomas KE, Hasbun R, Jekel J, Quagliarello VJ. The diagnostic accuracy of Kernig's sign, Brudzinski's sign, and nuchal rigidity in adults with suspected meningitis. Clinical Infectious Diseases. 2002;35(1):46-52.

Aminzadeh Z, Roudgari A. Jolt accentuation of headache in diagnosis of acute meningitis. Iranian Journal of Clinical Infectious Disease. 2010;5(2):106-9.

Thomas KE, Hasbun R, Jekel J, Quagliarello VJ. The diagnostic accuracy of Kernig’s sign, Brudzinski’s sign, and nuchal rigidity in adults with suspected meningitis Clin Infect Dis. 2002;35:46-52.

Nakao JH, Jafri FN, Shah K, Newman DH. Jolt accentuation of headache and other clinical signs: poor predictors of meningitis in adults. Am J Emerg Med. 2014;32(1):24-8.

Hussein AS, Shafran SD. Acute bacterial meningitis in adults. A 12-year review. Medicine (Baltimore). 2000;79:360-8.

Riordan FA, Thomson AP, Sills JA, Hart CA. Who spots the spots? Diagnosis and treatment of early meningococcal disease in children. BMJ. 1996;313:1255-6.




DOI: https://doi.org/10.22037/emergency.v6i1.18226

Refbacks

  • There are currently no refbacks.