Cochrane · systematic review · CD012824
Diagnostic test accuracy of jolt accentuation for headache in acute meningitis in the emergency setting
Iguchi, M, Noguchi, Y, Yamamoto, S, et al. · Cochrane Database of Systematic Reviews · 2020 · Cochrane Library
Acute Respiratory InfectionsAMSTAR 2: not assessed
SoF tableOnly the outcomes this review put in its Summary of Findings table are listed (the Cochrane Handbook caps them at about seven per comparison). Its other analyses are not shown here.
Questions
12
current version
GRADE rated
8
No studies
4
Included studies
NR
No studies 4 · 33.3%Ungraded 0 · 0%Very low 8 · 66.7%Low 0 · 0%Moderate 0 · 0%High 0 · 0%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Questions and results
Accuracy of jolt accentuation of headache for diagnosing acute meningitis in the emergency setting
Population: people of any age with suspected acute meningitis in the emergency settingPrior testing: clinical information would act as prior testIndex test: jolt accentuation of headacheAlternative tests: nuchal rigidity, Kernig's sign, Brudzinski's sign, and neck flexion testImportance: knowledge of the sensitivity of jolt accentuation of headache would help answer the clinical question whether patients suspected to have acute meningitis avoid lumbar puncture or notReference standard: cerebrospinal fluid pleocytosis, proof of causative agents, and confirmed by autopsyStudies: cross‐sectional studiesPooled sensitivity: 65.3% (95% CI 37.3 to 85.6%); pooled specificity: 70.4% (95% CI 47.7 to 86.1)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Test result | no estimate extracted | NR | No studies |
Correctly detected (true positives) | no estimate extracted | 9 studies · 1161 participants | Very low Downgraded: risk of bias, imprecision, inconsistency, indirectness, publication bias |
Missed (false negatives) | no estimate extracted | 9 studies · 1161 participants | Very low Downgraded: risk of bias, imprecision, inconsistency, indirectness, publication bias |
Correctly excluded (true negatives) | no estimate extracted | 9 studies · 1161 participants | Very low Downgraded: risk of bias, imprecision, inconsistency, indirectness, publication bias |
Test positive, but not acute meningitis (false positives) | no estimate extracted | 9 studies · 1161 participants | Very low Downgraded: risk of bias, imprecision, inconsistency, indirectness, publication bias |
CI: confidence interval | no estimate extracted | NR | No studies |
Accuracy of jolt accentuation of headache for diagnosing acute meningitis in the emergency setting (for participants without consciousness disturbance)
Population: people without consciousness disturbance of any age with suspected acute meningitis in the emergency settingPrior testing: clinical information would act as prior testIndex test: jolt accentuation of headacheAlternative tests: nuchal rigidity, Kernig's sign, Brudzinski's sign, and neck flexion testImportance: knowledge of the sensitivity of jolt accentuation of headache would help answer the clinical question whether patients suspected to have acute meningitis avoid lumbar puncture or notReference standard: cerebrospinal fluid pleocytosis, proof of causative agents, and confirmed by autopsyStudies: cross‐sectional studiesPooled sensitivity: 75.2% (95% CI 54.3 to 88.6%); pooled specificity: 60.8% (95% CI 43.4 to 75.9)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Test result | no estimate extracted | NR | No studies |
Correctly detected (true positives) | no estimate extracted | 8 studies · 921 participants | Very low Downgraded: risk of bias, imprecision, inconsistency, indirectness, publication bias |
Missed (false negatives) | no estimate extracted | 8 studies · 921 participants | Very low Downgraded: risk of bias, imprecision, inconsistency, indirectness, publication bias |
Correctly excluded (true negatives) | no estimate extracted | 8 studies · 921 participants | Very low Downgraded: risk of bias, imprecision, inconsistency, indirectness, publication bias |
Test positive, but not acute meningitis (false positives) | no estimate extracted | 8 studies · 921 participants | Very low Downgraded: risk of bias, imprecision, inconsistency, indirectness, publication bias |
CI: confidence interval | no estimate extracted | NR | No studies |