Absence of jolt accentuation of headache cannot accurately rule out meningitis in adults

Jolt accentuation and its value as a sign in diagnosis of meningitis in patients with fever and headache

“…Ex. which has had a range of sensitivity (6–97%) reported in different studies [9], [10], [11], [12], [13]; this wide range could be due to the variation in sample size, common regional pathogens, and basic characteristics of patients [10].…”

“…Sensitivity, specificity, LR + , and LR − of Jolt accentuation was achieved as 63.9%, 43.2%, 1.12, and 0.84, respectively and the authors concluded that existing physical examination. clues are not able to detect patients suspected to have meningitis [10].…”

“…There are multiple signs detectable during the physical examination to make the diagnosis of meningitis, such as nuchal rigidity, Kernig's sign, Brudzinski's sign, and Jolt accentuation [7], [8], [9]. Jolt accentuation is a sign that different studies have shown heterogeneous results about its accuracy [10], [11]. Previous studies could not find jolt accentuation as an accurate diagnostic test to confirm the diagnosis of acute bacterial meningitis [5], [10].…”

“…Jolt accentuation is a sign that different studies have shown heterogeneous results about its accuracy [10], [11]. Previous studies could not find jolt accentuation as an accurate diagnostic test to confirm the diagnosis of acute bacterial meningitis [5], [10].…”

Clouding Jolt Accentuation by Cloudy Clinical Setting for Lumbar Puncture

“…Now, Sato et al challenge this diagnostic value of JA by asking “Can we rule out meningitis from negative jolt accentuation?” in an extended retrospective cohort without such patient selection. Because negative JA in patients with pleocytosis has been noted in a patient with Sjogren syndrome in the initial study and has been since confirmed by subsequent retrospective studies, the answer to the authors’ question is apparently “No.” The results on JA have been variable due to population bias (where the study was performed), how the patients were recruited to the study (recruitment bias), how the data were collected, and how the data were interpreted (interpretation bias) to settle clinical questions . Anyway, it was fortunate that this simple method has been routinely used in an emergency setting to raise suspicion of meningitis.…”