To read the full review go to Diagnostic test accuracy of jolt accentuation for headache in acute meningitis in the emergency setting

Plain language summary

Why is the diagnosis of acute meningitis by physical examination important?

Meningitis is inflammation of the tissue that protects the brain and spinal cord (the meninges). Acute meningitis, especially bacterial and tubercular meningitis, is potentially life-threatening, and requires prompt diagnosis and early treatment.

Diagnosis usually needs an analysis of cerebrospinal fluid collected by lumbar puncture. Lumbar puncture involves the insertion of a needle between the bones of the lumbar spine. Lumbar puncture is an invasive test that can cause headache.

If physical examination can accurately exclude the possibility of acute meningitis, patients may be able to avoid having to undergo a lumbar puncture. However, traditional physical examinations of people with suspected meningitis, such as inability to flex the neck forward (nuchal rigidity), does not exclude acute meningitis.

What is the aim of this review?

We aimed to estimate how accurate jolt accentuation of headache is for diagnosis of acute meningitis in emergency settings. Jolt accentuation of headache is a more recent (1991) and less well-recognised physical examination compared to other tests. Jolt accentuation involves making the headache worse by rotating the head horizontally two or three times per second.

What was studied in this review?

We studied jolt accentuation of headache in people who presented with potential acute meningitis in emergency settings.

What are the main results of this review?

We included nine studies involving 1161 participants who presented with potential acute meningitis. Five studies included only adults, and four studies included both adults and children. Due to lack of data, we could not perform separate analyses for adults and children.

How confident are we in the results of the review?

It appears that jolt accentuation of headache is not sensitive enough to exclude a diagnosis of acute meningitis.

To whom do the review's results apply?

People who present with potential acute meningitis. Most studies targeted emergency settings, therefore it is uncertain whether the test would work in primary care settings. Most studies included adults or adolescents; the youngest participant was aged 13 years. There is no evidence that this test is applicable for children.

What are the implications of this review?

Even where jolt accentuation of headache is negative, there is still the possibility of acute meningitis.

How up-to-date is this review?

We searched for studies published up to 27 April 2020.