Bacterial Meningitis: Sensitivity and Specificity

Introduction: i.e. acute meningitis

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The sensitivity and specificity of findings for Bacterial Meningitis are listed below. See the left navigation bar to change the display.

Sensitive and Specific Findings

CSF Gram Stain

86%

100%

older studies gave sensitivity closer to 60%.

Study: JAMA. 2006 Oct 25;296(16):2012-22. PMID: 17062865

CSF Lactate

89%

96%

>=31.5mg/dl

Study: JAMA. 2006 Oct 25;296(16):2012-22. PMID: 17062865

Specific Findings

Finding	Sensitivity	Specificity	Comments, Study
CSF Glucose	51%	98%	>39.6mg/dl Study: JAMA. 2006 Oct 25;296(16):2012-22. PMID: 17062865
Brudzinski Sign	2%	98%	Not well studied. Brudzinski's original study gave sensitivity of 97%. His best known "nape of the neck" sign (Brudzinski sign) is present when passive neck flexion in a supine patient results in flexion of the knees and hips. A separate sign, the contralateral reflex, is present if passive flexion of one hip and knee causes flexion of the contralateral leg. Study: 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 Jan;32(1):24-8.
hearing loss Duplicate	2%	97%	The maneuver is most commonly performed with the patient lying supine and the hip flexed at 90°. A positive sign is present when extension of the knee from this position elicits resistance or pain in the lower back or posterior thigh.rnrnone study. Brudzinsksi's original study had a sensitivity of 57%. Study: 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 Jan;32(1):24-8.
CSF-Blood Glucose Ratio	70%	96%	<=0.4 Study: JAMA. 2006 Oct 25;296(16):2012-22. PMID: 17062865
CSF Leukocytosis	71%	95%	>=500/ul Study: JAMA. 2006 Oct 25;296(16):2012-22. PMID: 17062865

Sensitive Findings

Jolt Accentuation of Headache

97%

60%

Ask the patient to turn his or her head horizontally at a frequency of 2 to 3 rotations per second. Worsening of a baseline headache represents a positive sign.

Study: JAMA. 1999 Jul 14;282(2):175-81. PMID: 10411200

hearing loss
Duplicate

Sensitivity = 85%

specificity not assessed

Study: JAMA. 1999 Jul 14;282(2):175-81. PMID: 10411200

Negative Findings

hearing loss
Duplicate

97%

The maneuver is most commonly performed with the patient lying supine and the hip flexed at 90°. A positive sign is present when extension of the knee from this position elicits resistance or pain in the lower back or posterior thigh.rnrnone study. Brudzinsksi's original study had a sensitivity of 57%.

Study: 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 Jan;32(1):24-8.

Poorly Diagnostic Findings

Finding	Sensitivity	Specificity	Comments, Study
Neck Stiffness	Sensitivity = 70%		specificity not assessed, however: 13% of the acute-care patients and 35% of the geriatric patients had nuchal rigidity despite the absence of meningitis. Study: JAMA. 1999 Jul 14;282(2):175-81. PMID: 10411200
Altered Mental Status	Sensitivity = 67%		specificity not assessed Study: JAMA. 1999 Jul 14;282(2):175-81. PMID: 10411200
Headache	Sensitivity = 50%		specificity not assessed. One study gave sensitivity of 15% and specificity of 100%. Study: JAMA. 1999 Jul 14;282(2):175-81. PMID: 10411200
Fever, Neck Stiffness, and Altered Mental Status	Sensitivity = 46%		specificity not assessed Study: JAMA. 1999 Jul 14;282(2):175-81. PMID: 10411200
Neck Pain	Sensitivity = 28%		specificity not assessed. One study. Study: JAMA. 1999 Jul 14;282(2):175-81. PMID: 10411200
Focal Neurological Signs	Sensitivity = 23%		specificity not assessed Study: JAMA. 1999 Jul 14;282(2):175-81. PMID: 10411200
Rash	Sensitivity = 22%		specificity not assessed Study: JAMA. 1999 Jul 14;282(2):175-81. PMID: 10411200