THE
DIAGNOSTIC ACCURACY OF KERNIG'S SIGN, BRUDZINSKI'S SIGN, AND NUCHAL RIGIDITY IN
ADULTS WITH SUSPECTED MENINGITIS.
Thomas
KE, et al. Clin Infect Dis 2002 Jul 1;35(1):46-52
BACKGROUND:
To determine the diagnostic accuracy of Kernig's sign, Brudzinski's sign, and
nuchal rigidity for meningitis, 297 adults with suspected meningitis were
prospectively evaluated for the presence of these meningeal signs before lumbar
puncture was done.
RESULTS:
Kernig's sign (sensitivity, 5%; likelihood ratio for a positive test result
[LR(+)], 0.97), Brudzinski's sign (sensitivity, 5%; LR(+), 0.97), and nuchal
rigidity (sensitivity, 30%; LR(+), 0.94) did not accurately discriminate
between patients with meningitis (>/=6 white blood cells [WBCs]/mL of
cerebrospinal fluid [CSF]) and patients without meningitis. The diagnostic
accuracy of these signs was not significantly better in the subsets of patients
with moderate meningeal inflammation (>/=100 WBCs/mL of CSF) or
microbiological evidence of CSF infection. Only for 4 patients with severe
meningeal inflammation (>/=1000 WBCs/mL of CSF) did nuchal rigidity show
diagnostic value (sensitivity, 100%; negative predictive value, 100%).
CONCLUSION:
In the broad spectrum of adults with suspected meningitis, 3 classic meningeal
signs did not have diagnostic value; better bedside diagnostic signs are
needed.