Tools

Add a finding for this diagnosis

Add prevalence for this diagnosis

Switch to calculator mode to see positive predictive value

Switch to sensitivity and specificity

Sort findings by Tag

Sort findings by Differential Diagnosis

Jump To

Good Positive and Negative Likelihood Ratios

Poorly Diagnostic Findings

Bacterial Meningitis: Likelihood Ratios

Introduction: i.e. acute meningitis

[Edit Diagnosis] [Merge dx] [Add prevalence]

Tags: Infection Tag this Diagnosis.

The likelihood ratios of findings for Bacterial Meningitis are listed below. See the left navigation bar to change the display.

Good Positive and Negative Likelihood Ratios

Finding	+LR	-LR	Comments, Study
CSF Gram Stain	inf	0.1	older studies gave sensitivity closer to 60%. Study: JAMA. 2006 Oct 25;296(16):2012-22. PMID: 17062865
Jolt Accentuation of Headache	2.4	0.1	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
CSF Lactate	21	0.1	>=31.5mg/dl Study: JAMA. 2006 Oct 25;296(16):2012-22. PMID: 17062865
CSF Leukocytosis	15	0.3	>=500/ul Study: JAMA. 2006 Oct 25;296(16):2012-22. PMID: 17062865
CSF-Blood Glucose Ratio	18	0.3	<=0.4 Study: JAMA. 2006 Oct 25;296(16):2012-22. PMID: 17062865
CSF Glucose	23	0.5	>39.6mg/dl Study: JAMA. 2006 Oct 25;296(16):2012-22. PMID: 17062865

Poorly Diagnostic Findings

Finding	+LR	-LR	Comments, Study
Brudzinski Sign	1	1	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	0.7	1	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.
hearing loss Duplicate	Sensitivity = 85%		specificity not assessed Study: JAMA. 1999 Jul 14;282(2):175-81. PMID: 10411200
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