Table 2.
Studies in the literature performed to address the meningeal signs in adults (only studies included that at least make an estimation of the numbers of older people).
| Waghdhare et al.∗ [22] | Weisfelt et al. [23] | Rasmussen et al. [24] | Thomas et al.∗ [25] | Alavi and Moogahi [21] | Majed et al. [26] | |
|---|---|---|---|---|---|---|
| Location | Maharashtra, India | Netherlands | Denmark | New Haven, USA | Ahwaz, Iran | Arras, France |
|
| ||||||
| Date | 2010 | 1998–2002 | 1976–1988 | 2002 | 2006-2007 | 2004-2005 |
|
| ||||||
| Age | 13–81 (38 ± 18) | Elderly: 71 ± 7.5 Younger: 38 ± 14 |
18–93 (40) | Male: 74.4 ± 6.21 Female: 73.8 ± 8.31 |
36–72 (52) | |
|
| ||||||
| Inclusion criteria | Acute encephalitis syndrome (≥12 yrs) | Culture proven community-acquired bacterial meningitis (≥16 yrs) | Acute bacterial meningitis (≥60 yrs) | Adults with suspected meningitis | Fever and confusion (≥56 yrs) | All adult patients who underwent an LP |
|
| ||||||
| Study Design | Double blind, cross-sectional | Prospective, cohort | Retrospective | Prospective | Not mentioned | Retrospective |
|
| ||||||
| Total number of participants | 190 | 696 | 48 | 297 Number of cases with meningitis: 80 |
60 Number of cases with meningitis: 6 |
247 |
|
| ||||||
| Total number of elderly patients | 25/190 (13.1%) | 257/696 (37%) | 48/48 (100%) | 46/297 (15.8%) Number of elderly patients with meningitis: 9/80 (11.2%) |
60/60 (100%) Number of elderly patients with meningitis: 6/6 (100%) |
87/247 (35.2%) Number of elderly patients with meningitis: 3/87 (3.4%) |
|
| ||||||
| Results | Nuchal rigidity: LR+ 1.33 (0.89, 1.98) LR− 0.86 (0.70, 1.06) Kernig: LR+ 1.84 (0.77, 4.35) LR− 0.93 (0.84, 1.03) Brudzinski: LR+ 1.69 (0.65, 4.37) LR− 0.95 (0.87, 1.04) Jolt: LR+ 5.52 (0.67, 44.9) LR− 0.95 (0.89, 1.00) |
Neck stiffness: elderly 78% versus younger 81% Classic triad (fever, neck stiffness, and altered mental status): Elderly 58% versus younger 36% |
Meningeal signs: 54% | Nuchal rigidity: sensitivity 30%, LR+ 0.94 Kernig: sensitivity 5%, LR+ 0.97 Brudzinski: sensitivity 5%, LR+ 0.97 |
Meningeal signs: 6/6 (100%) of bacterial meningitis versus 32/54 (59%) of elderly patients with fever and confusion who had infection outside the CNS | Neck stiffness: elderly patients who underwent LP: 31/87 (35%) of whom only 3/87 (3.4%) had meningitis 33.9% of patients less than 35 years and 29.8% of patients between 35 and 65 years had neck stiffness, of whom 23.2% and 11.5% had meningitis |
∗No comparison was made between elderly and younger patients in regard to the frequency of meningeal signs
LP: lumbar puncture; LR: likelihood ratio.