Absence of jolt accentuation of headache cannot accurately rule out meningitis in adults.
BACKGROUND
Meningitis is a common emergency disease. Signs and symptoms easily observed at the bedside are needed because early recognition of the possibility of meningitis is necessary for the decision to perform lumbar puncture. Jolt accentuation of headache has been reported to be the most sensitive diagnostic test; however, limited articles have reproduced its sensitivity.


METHODS
This is a single-center retrospective medical record review between 2007 and 2012. We diagnosed meningitis based on the criterion standard that cerebrospinal fluid total cells is more than 5/mm(3), in accordance with previous studies. All diagnostic and management decisions including Kernig sign, nuchal rigidity, and jolt accentuation of headache were at the physician's discretion. We calculated the sensitivity and specificity of well-known signs and symptoms of meningitis and, especially, compared the efficacy of jolt accentuation of headache with previous studies.


RESULTS
We investigated 531 adult patients who were suspected of meningitis and had lumbar puncture performed. Of these patients, 139 had meningitis. Background characteristics and vital signs were not clinically different between the 2 groups, although classic tetralogy of bacterial meningitis (fever, nuchal rigidity, mental disturbance, and headache) was worth investigated. The sensitivity and specificity of jolt accentuation of headache were 63.9% (95% confidence interval, 51.9%-76.0%) and 43.2% (34.7%-51.6%), respectively.


CONCLUSIONS
The absence of jolt accentuation of headache test cannot, on its own, accurately rule out meningitis in adults. Further studies are warranted to reproduce this result and to discover better bedside diagnostic tests.
Department of Emergency Rescue, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan. Electronic address: tamune-tky@umin.ac.jp.
Hidetaka
H
Tamune
Hiroaki
H
Takeya
Wakako
W
Suzuki
Yasuaki
Y
Tagashira
Takaie
T
Kuki
Mitsuhiro
M
Nakamura
D005260:Female; D019416:Head Movements; D006261:Headache / Q000209:etiology*; D006801:Humans; D008297:Male; D008581:Meningitis / Q000134:cerebrospinal fluid / Q000150:complications / Q000175:diagnosis*; D008875:Middle Aged; D010808:Physical Examination; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D013129:Spinal Puncture