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Table 3 Sensitivity, specificity, PPV, NPV, + LR and − LR of evaluated signs in compare to previous studies

From: Jolt accentuation of headache: can this maneuver rule out acute meningitis?

Author Study population Micro-organism (frequency) Sign/maneuver Sensitivity % Specifity % PPV NPV LR + LR −
(0.95 CI) (0.95 CI) (0.95 CI) (0.95 CI)
Uchihara [9]a 54 Viral (28)
Bacterial (1)
Tuberculosis (1)
Jolt accentuation 97.1 60 80.5 92.3 4.2 0.0
Thomas et al. [8]b 297 Viral (9)
Bacterial (3)
Fungal (6)
Jolt accentuation NR NR NR NR NR NR
Nuchal rigidity 30 68 26 73 0.94 1.02
Kernig’s sign 5 95 27 72 0.97 1
Brudzinski sign 5 95 27 72 0.97 1
Aminzadeh et al. [11]a 14 Undefined Jolt accentuation 100 71.5 78 100 1 0
Nuchal rigidity 100 57 70 100 2.33 0
Waghdhare et al. [6]a 190 Viral (62)
Bacterial (7)
Tuberculosis (30)
Jolt accentuation 6.06 (2.26–12.7) 98.9 (94–100) NR NR 5.52 0.95
Nuchal rigidity 39.4 (29.7–49.7) 70.3 (59.8–79.5) NR NR 1.33 0.86
Kernig’s sign 14.1 (7.95–22.6) 92.3 (84.8–96.9) NR NR 1.84 0.93
Brudzinski sign 11.1 (5.68–19) 93.4 (86.2–97.5) NR NR 1.69 0.95
Tamune et al. [12]c,d 113 Viral (38) Jolt accentuation 78.9 (66.0–91.9) 32.0 (21.4–42.6) NR NR 1.16 0.66
Nakao et al. [7]a 230 Viral (1)
Bacterial (1)
Fungal (1)
Jolt accentuation 21 82 NR NR 1.2 1
Nuchal rigidity 13 80 NR NR 0.6 1.1
Kernig’s sign 2 97 NR NR 0.8 1
Brudzinski sign 2 98 NR NR 1 1
Sato et al. [13]a,e 108 Undefined Jolt accentuation 75 (61.8–84.8) 35.1 (24–48) NR NR 1.16 0.71
This study 227 Bacterial (1)
Fungal (1)
Jolt accentuation 62.5 (49.4–74) 88.3 (82.1–92.6) 67.7 (54.2–79) 85.7 (79.2–90.4) 5.36 0.42
Nuchal rigidity 77.7 (65.2–86.9) 56.4 (48.4–64.1) 40.8 (32–50.1) 86.7 (78.5–92.3) 1.78 0.39
Kernig’s sign 50 (37.362.6) 92.6 (87.2–95.9) 72.7 (56.9–84.5) 82.5 (76–87.5) 6.79 0.53
Brudzinski sign 64 (51.3–75.3) 74.2 (66.6–80.6) 49.3 (38.3–60.5) 84 (76.7–89.4) 2.48 0.48
  1. NR no result
  2. aMeningitis was defined as WBC > 5 cell/µl
  3. bMeningitis was defined as WBC > 6 cell/µl
  4. cMeningitis was defined as WBC > 15.3 cell/µl
  5. dStudy population was 193 patients and 113 had fever and headache without loss of consciousness
  6. eConscious patients