The Optimal Management of Acute Febrile Encephalopathy in the Aged Patient: A Systematic Review

Table 2

Studies in the literature performed to address the meningeal signs in adults (only studies included that at least make an estimation of the numbers of older people).

	Waghdhare et al. [22]	Weisfelt et al. [23]	Rasmussen et al. [24]	Thomas et al. [25]	Alavi and Moogahi [21]	Majed et al. [26]
Location	Maharashtra, India	Netherlands	Denmark	New Haven, USA	Ahwaz, Iran	Arras, France
Date	2010	1998–2002	1976–1988	2002	2006-2007	2004-2005
Age	13–81 (38 ± 18)	Elderly: 71 ± 7.5; Younger: 38 ± 14		18–93 (40)	Male: 74.4 ± 6.21; Female: 73.8 ± 8.31	36–72 (52)
Inclusion criteria	Acute encephalitis syndrome (≥12 yrs)	Culture proven community-acquired bacterial meningitis (≥16 yrs)	Acute bacterial meningitis (≥60 yrs)	Adults with suspected meningitis	Fever and confusion (≥56 yrs)	All adult patients who underwent an LP
Study Design	Double blind, cross-sectional	Prospective, cohort	Retrospective	Prospective	Not mentioned	Retrospective
Total number of participants	190	696	48	297; Number of cases with meningitis: 80	60; Number of cases with meningitis: 6	247
Total number of elderly patients	25/190 (13.1%)	257/696 (37%)	48/48 (100%)	46/297 (15.8%); Number of elderly patients with meningitis: 9/80 (11.2%)	60/60 (100%); Number of elderly patients with meningitis: 6/6 (100%)	87/247 (35.2%); Number of elderly patients with meningitis: 3/87 (3.4%)
Results	Nuchal rigidity: LR+ 1.33 (0.89, 1.98); LR− 0.86 (0.70, 1.06); Kernig: LR+ 1.84 (0.77, 4.35); LR− 0.93 (0.84, 1.03); Brudzinski: LR+ 1.69 (0.65, 4.37); LR− 0.95 (0.87, 1.04); Jolt: LR+ 5.52 (0.67, 44.9); LR− 0.95 (0.89, 1.00)	Neck stiffness: elderly 78% versus younger 81%; Classic triad (fever, neck stiffness, and altered mental status): Elderly 58% versus younger 36%	Meningeal signs: 54%	Nuchal rigidity: sensitivity 30%, LR+ 0.94; Kernig: sensitivity 5%, LR+ 0.97; Brudzinski: sensitivity 5%, LR+ 0.97	Meningeal signs: 6/6 (100%) of bacterial meningitis versus 32/54 (59%) of elderly patients with fever and confusion who had infection outside the CNS	Neck stiffness: elderly patients who underwent LP: 31/87 (35%) of whom only 3/87 (3.4%) had meningitis; 33.9% of patients less than 35 years and 29.8% of patients between 35 and 65 years had neck stiffness, of whom 23.2% and 11.5% had meningitis

No comparison was made between elderly and younger patients in regard to the frequency of meningeal signs
LP: lumbar puncture; LR: likelihood ratio.