Can We Rule Out Meningitis from Negative Jolt Accentuation? A Retrospective Cohort Study
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Published on: September 3, 2021
Ryota Sato1, Akira Kuriyama2, Sarah Kyuragi Luthe3
1Department of Emergency and Critical Care Medicine, Urasoe General Hospital, Okinawa, Japan.
Background:
Jolt accentuation has been considered to be the most sensitive physical finding to predict meningitis. However, there are only a few studies assessing the diagnostic accuracy of jolt accentuation. Therefore, we aimed to evaluate the diagnostic accuracy of jolt accentuation and investigate whether it can be extended to patients with mild altered mental status.
Methods:
We performed a single center, retrospective observational study on patients who presented to the emergency department in a Japanese tertiary care center from January 1, 2010 to March 31, 2016. Jolt accentuation evaluated in patients with fever, headache, and mild altered mental status with Glasgow Coma Scale no lower than E2 or M4 was defined as "jolt accentuation in the broad sense." Jolt accentuation evaluated in patients with fever, headache, and no altered mental status was defined as "jolt accentuation in the narrow sense." We evaluated the sensitivity and specificity in both groups.
Results:
Among 118 patients, the sensitivity and specificity of jolt accentuation in the broad sense were 70.7% (95% confidence interval (CI): 58.0%-80.8%) and 36.7% (95% CI: 25.6%-49.3%). The positive likelihood ratio and negative likelihood ratio were 1.12 (95% CI: 0.87-1.44) and 0.80 (95% CI: 0.48-1.34), respectively. Among 108 patients, the sensitivity and specificity of jot accentuation in the narrow sense were 75.0% (95% CI: 61.8%-84.8%) and 35.1% (95% CI: 24.0%-48.0%). The positive likelihood ratio and negative likelihood ratio were 1.16 (95% CI: 0.90-1.48) and 0.71 (95% CI: 0.40-1.28), respectively.
Conclusions:
Jolt accentuation itself has a limited value in the diagnosis of meningitis regardless of altered mental status. Therefore, meningitis should not be ruled out by negative jolt accentuation.
Insights
Jolt accentuation has limited diagnostic value for meningitis, even in patients with altered mental status. A negative jolt accentuation test should not rule out meningitis.
Area of Science:
- Neurology
- Infectious Diseases
- Diagnostic Accuracy
Background:
- Jolt accentuation is often considered a sensitive indicator for meningitis.
- Limited studies exist on the diagnostic accuracy of jolt accentuation.
- The utility of jolt accentuation in patients with altered mental status requires further investigation.
Purpose of the Study:
- To evaluate the diagnostic accuracy of jolt accentuation in predicting meningitis.
- To determine if jolt accentuation is effective in patients with mild altered mental status.
Main Methods:
- A retrospective observational study was conducted at a Japanese tertiary care center.
- Patients presenting with fever and headache were included.
- Jolt accentuation was assessed in two groups: with and without altered mental status (broad vs. narrow sense).
Main Results:
- In the broad sense (including altered mental status), sensitivity was 70.7% and specificity was 36.7%.
- In the narrow sense (no altered mental status), sensitivity was 75.0% and specificity was 35.1%.
- Likelihood ratios indicated limited diagnostic value in both groups.
Conclusions:
- Jolt accentuation alone has limited value in diagnosing meningitis.
- A negative jolt accentuation finding should not be used to exclude meningitis.
- Further diagnostic evaluation is necessary even with a negative jolt accentuation test.
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