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Am Fam Physician. 2000;62(3):508

An item in “Tips from Other Journals” (January 15, 2000, page 493), entitled “Diagnosis of Acute Meningitis in Adult Patients,” contained an error. Near the end of the first paragraph of the right-hand column on page 493, the text mentions that the Brudzinski sign has a 97 percent sensitivity in the diagnosis of acute meningitis in adults. Neck stiffness has a pooled sensitivity of 70 percent. Although Brudzinski's original study (which included 42 patients, one half of whom had tuberculous meningitis) reported a sensitivity of 97 percent for the Brudzinski sign, there have been no subsequent studies evaluating this sign. The Kernig sign was found to have a sensitivity of 57 percent in the original study, but a later study reported a sensitivity of only 9 percent. The authors of the study reviewed in this Tip concluded that meningitis can be ruled out if a patient does not have fever, stiff neck or mental status changes. Fever is the most sensitive of the three signs, and neck stiffness is the next most sensitive. Kernig and Brudzinski signs, although poorly tested, seem to be specific for the diagnosis of meningitis. The authors do not believe that either sign is sensitive enough to be used for making the diagnosis of meningitis.

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