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Bacterial Meningitis: Sensitivity and Specificity

Introduction: i.e. acute meningitis

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Tags: Infection Tag this Diagnosis.

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

Finding SensitivitySpecificity Comments, Study
CSF Gram Stain Edit 86%100%

older studies gave sensitivity closer to 60%.

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

CSF Lactate Edit 89%96%

>=31.5mg/dl

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

Specific Findings

Finding SensitivitySpecificity Comments, Study
CSF Glucose Edit 51%98%

>39.6mg/dl

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

Brudzinski Sign Edit 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.

Fever
Duplicate Edit
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 Edit 70%96%

<=0.4

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

CSF Leukocytosis Edit 71%95%

>=500/ul

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

Sensitive Findings

Finding SensitivitySpecificity Comments, Study
Jolt Accentuation of Headache Edit 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

Fever
Duplicate Edit
Sensitivity = 85%

specificity not assessed

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

Negative Findings

Finding SensitivitySpecificity Comments, Study
Fever
Duplicate Edit
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.

Poorly Diagnostic Findings

Finding SensitivitySpecificity Comments, Study
Neck Stiffness Edit 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 Edit Sensitivity = 67%

specificity not assessed

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

Headache Edit 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 Edit Sensitivity = 46%

specificity not assessed

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

Neck Pain Edit Sensitivity = 28%

specificity not assessed. One study.

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

Focal Neurological Signs Edit Sensitivity = 23%

specificity not assessed

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

Rash Edit Sensitivity = 22%

specificity not assessed

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