CAT: Therapy: Meningitis: Head Jolting

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MENINGITIS: HEAD JOLTING AND CSF PLEOCYTOSIS

Clinical bottom line:
Prevalence of CSF pleocytosis (Pre-test Probability) = 34/54 = .63
SnNOUT: most sensitive clinical manouever (Se = 97.1% [33/34]): head jolting (exacerbation of headache induced by rotation of the head horizontally twice or three times per second)
SpPIN: most specific clinical manouevers are presence of neck stiffness (Sp=100%) and Kernig's sign (Sp= 100%)

Appraised by: S. Sauvé & DL Sackett, February 4th 1993

The Gold Standard: Lumbar puncture, > 5 white cells /cubic mm.

The Study Setting: Japan, out-patient, ER and admitted patients assessed for recent-onset headaches in the presence of Temp>37. Prospective study with clinical manouevers performed prior to LP.

The Evidence:

Diagnostic test result Sensitivity Specificity Likelihood Ratio when Positive Likelihood Ratio when Negative

head jolting .97 [33/34] .60 [12/20] 2.4
[1.6 , 4.4] 0.05
(SnNout)

neck stiffness .15 [5/34] 1.00 [20/20] INF (SpPin) 0.85

kernig's sign .09 [3/34] 1.00 [20/20] INF (SpPin) 0.91

Diagnostic test result	Sensitivity	Specificity	Likelihood Ratio when Positive	Likelihood Ratio when Negative
head jolting	.97 [33/34]	.60 [12/20]	2.4 [1.6 , 4.4]	0.05 (SnNout)
neck stiffness	.15 [5/34]	1.00 [20/20]	INF (SpPin)	0.85
kernig's sign	.09 [3/34]	1.00 [20/20]	INF (SpPin)	0.91

Comments:

needs to be independently validated before can be used to SnNOUT or SpPIN.

References:

Uchihara T, Tsukagoshi H. Jolt accentuation of headache: the most sensitive sign of CSF pleocytosis. Headache 1991;31:167-171.

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