Thomas Karen E, Hasbun Rodrigo, Jekel James, Quagliarello Vincent J
Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, 06520, USA.
Clin Infect Dis. 2002 Jul 1;35(1):46-52. doi: 10.1086/340979. Epub 2002 Jun 5.
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. 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%). In the broad spectrum of adults with suspected meningitis, 3 classic meningeal signs did not have diagnostic value; better bedside diagnostic signs are needed.
为确定克尼格征、布鲁津斯基征及颈项强直对脑膜炎的诊断准确性，对297例疑似脑膜炎的成人患者在进行腰椎穿刺前，前瞻性评估这些脑膜刺激征的存在情况。克尼格征（敏感性5%；阳性试验结果的似然比[LR(+)]，0.97）、布鲁津斯基征（敏感性5%；LR(+)，0.97）及颈项强直（敏感性30%；LR(+)，0.94）不能准确区分脑膜炎患者（脑脊液[CSF]中白细胞[WBC]≥6个/mL）和非脑膜炎患者。在中度脑膜炎症患者亚组（CSF中WBC≥100个/mL）或CSF感染微生物学证据的患者中，这些体征的诊断准确性并无显著提高。仅在4例重度脑膜炎症患者（CSF中WBC≥1000个/mL）中，颈项强直显示出诊断价值（敏感性100%；阴性预测值100%）。在广泛的疑似脑膜炎成人患者中，3种经典脑膜刺激征并无诊断价值；需要更好的床旁诊断体征。
