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KMID : 1039620120020040311
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Korean Journal of Family Practice
2012 Volume.2 No. 4 p.311 ~ p.317
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The Diagnostic Accuracy of Kernig’s Sign, Brudzinski’s Sign, Nuchal Rigidity, and Jolt Accentuation of Headache in Adults with Suspected Meningitis
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Kim Ja-Young
Sung Eun-Ju
Kim Yong-Bum
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Abstract
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Background: The purpose of this study is to determine the diagnostic accuracy of Kernig sign, Brudzinski sign, nuchal rigidity, and Jolt accentuation of headache in adult patients with suspected meningitis.
Methods: Study subjects were 249 patients with suspected meningitis who visited Kangbuk Samsung Hospital in Seoul from 2007 to 2009. We identifi ed symptoms, physical examination, cerebrospinal fl uid (CSF) analysis results, and diagnosis of patients through chart review. Sensitivity, specifi city, positive likelihood ratio, negative likelihood ratio, positive predictive value, and negative predictive value of each meningeal irritation sign was calculated.
Results: One hundred and thirty-seven patients (55%) were confirmed as meningitis (≥6 white blood cells [WBCs]/mL of CSF) by CSF analysis. The most common symptoms among them were headache (99.2%), febrile sense (83.9%), and nausea (72.9%). The sensitivity and specifi city of each test were as follows: Kernig’s sign (4.6%/97.8%), Brudzinski’s sign (2.3%/100%), nuchal rigidity (33%/97.8%), and Jolt accentuation of headache (89.6%/68.2%). The positive/negative likelihood ratio was 15.4/0.7 for nuchal rigidity and 2.8/0.2 for Jolt accentuation of headache. Diagnostic accuracy of these signs was not signifi cantly different in the subsets of patients with moderate meningeal infl ammation (≥100 WBCs/mL of CSF).
Conclusion: The classical meningeal irritation signs had low sensitivity to detect meningitis. Based on these fi ndings, Jolt accentuation might be useful for detection of meningitis in the primary care setting.
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KEYWORD
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Meningitis, Jolt Accentuation of Headache, Brudzinski Sign, Kernig Sign, Nuchal Rigidity
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