合理的な臨床検査について. この成人患者さんは急性髄膜炎を患っていますか?

J Attia¹, R Hatala, D J Cook

¹Department of Medicine, McMaster University, Hamilton, Ontario, Canada.

JAMA

|July 20, 1999

まとめ

臨床検査は低リスクの成人の脳髄膜炎を排除するのに役立ちますが,高リスクの患者はしばしば即時の腰椎穿刺を必要とします. 多くの髄膜炎の徴候は,さらなる研究が必要である.

科学分野:

神経学神経学とは
感染症感染症は感染症です.
クリニカル診断士

背景:

髄膜炎の早期臨床的認識は,早期の診断検査と治療開始に不可欠です.
髄膜炎の正確な診断は,臨床的評価と実験室での調査の組み合わせに依存しています.

研究の目的:

成人の髄膜炎における臨床検査結果の診断の正確性と精度を体系的に検討する.
髄膜炎の診断における特定の臨床的徴候および症状の有効性を評価する.

主な方法:

1966年から1997年にかけての英語とフランス語の研究に関する包括的な文献レビューを行った.
成人の細菌性またはウイルス性髄膜炎を客観的に確認した臨床検査を記述した10件の研究が含まれています.
基準基準,患者診断,臨床記述の再現性に基づいて研究の有効性を評価する.

主要な成果:

個々の臨床履歴の項目 (頭痛,吐き気/嘔吐) は,診断の正確性が低いことを示した.
発熱,首の硬直,精神状態の変化の欠如は,髄膜炎 (99%-100%の感度) を効果的に排除します.
頭痛の衝撃増幅は,発熱と頭痛の患者 (100%の感度) の有用な補助検査です.

結論:

臨床検査は,低リスクの成人のプレゼンテーションにおける髄膜炎を除外するために貴重なものです.
高リスクの患者は,髄膜炎の重症度により,しばしば直接の腰椎穿刺を必要とします.
多くの髄膜炎の徴候と症状を適切に研究するために,さらなる前向きな研究が必要である.

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