理性的临床检查. 这位成年患者是否患有急性脑膜炎?
1Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
JAMA
|July 20, 1999
概括
临床检查可以帮助排除低风险成年人的脑膜炎,但高风险的患者往往需要立即的腰部穿刺. 许多脑膜炎症状需要进一步研究.
科学领域:
- 神经学 神经学
- 传染性疾病 传染性疾病
- 临床诊断 临床诊断 临床诊断
背景情况:
- 脑膜炎的早期临床识别对于及时的诊断测试和治疗启动至关重要.
- 脑膜炎的准确诊断依赖于临床评估和实验室调查的结合.
研究的目的:
- 系统地审查成人脑膜炎临床检查结果的诊断准确性和精度.
- 为了评估特定的临床迹象和症状在诊断脑膜炎的有效性.
主要方法:
- 从1966年到1997年对英语和法语研究进行了全面的文献综述.
- 包括10项描述客观证实成年人细菌或病毒脑膜炎的临床检查的研究.
- 根据参考标准,患者确诊和临床描述的可复制性评估研究有效性.
主要成果:
- 个别临床病史项目 (头痛,恶心/吐) 的诊断准确度较低.
- 缺少发烧,部硬和精神状态变化有效排除脑膜炎 (99%-100%的灵敏度).
- 头痛的冲击突出是发烧和头痛患者 (100%的灵敏度) 的有用辅助测试.
结论:
- 临床检查对于排除低风险成年人呈现的脑膜炎有价值.
- 由于脑膜炎的严重程度,高风险患者通常需要直接的腰部穿刺.
- 需要进一步的前性研究,以充分研究许多脑膜炎的迹象和症状.
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