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The Rational Clinical Examination Copyright © American Medical Association. All rights reserved. | JAMA | The McGraw-Hill Companies, Inc. Does This Adult.

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Presentation on theme: "The Rational Clinical Examination Copyright © American Medical Association. All rights reserved. | JAMA | The McGraw-Hill Companies, Inc. Does This Adult."— Presentation transcript:

1 The Rational Clinical Examination Copyright © American Medical Association. All rights reserved. | JAMA | The McGraw-Hill Companies, Inc. Does This Adult Patient Have Acute Meningitis?

2 The Rational Clinical Examination Copyright © American Medical Association. All rights reserved. | JAMA | The McGraw-Hill Companies, Inc. Case Scenario 1 30-year-old man presents to emergency department (ED) 24-hour history of chills and a stiff neck Afebrile with normal mental status Full neck flexion but with cervical pain Kernig and Brudzinski signs absent

3 The Rational Clinical Examination Copyright © American Medical Association. All rights reserved. | JAMA | The McGraw-Hill Companies, Inc. in cr ea si n g i m p a c tI n c r e a s i ng im pa ct LR: Impact on Likelihood of Disease LR = 1No Impact on Likelihood of Disease 0 LR = 0.3Less Likely LR = 0.2Less Likely LR = 0.1Less Likely LR = 0.01Less Likely LR = 3More Likely LR = 5More Likely LR = 10More Likely LR = 100More Likely

4 The Rational Clinical Examination Copyright © American Medical Association. All rights reserved. | JAMA | The McGraw-Hill Companies, Inc. FindingLR+ (95% CI)LR– (95% CI) Fever0.82 ( )1.2 ( ) Kernig sign (Thomas)0.97 ( )1.0 ( ) Kernig sign (Uchihari)4.2 ( )0.92 ( ) Brudzinski sign0.97 ( )1.0 ( ) Jolt accentuation2.4 ( )0.05 ( ) Test Characteristics: Examination Likelihood Ratios From Prospective Studies

5 The Rational Clinical Examination Copyright © American Medical Association. All rights reserved. | JAMA | The McGraw-Hill Companies, Inc. 1% Pretest probability in population presenting to ED If positive, posttest probability = 2% Jolt accentuation test LR+ = 2.4 Jolt accentuation test LR– = 0.05 If negative, posttest probability < 0.1% Likelihood Ratio

6 The Rational Clinical Examination Copyright © American Medical Association. All rights reserved. | JAMA | The McGraw-Hill Companies, Inc. Terms of Use: The Rational Clinical Examination Education Guides PowerPoint Usage Guidelines JAMAevidence users may display, download, or print out PowerPoint slides and images associated with the site for personal and educational use only. Educational use refers to classroom teaching, lectures, presentations, rounds, and other instructional activities, such as displaying, linking to, downloading, printing, and making and distributing multiple copies of said isolated materials in both print and electronic format. Users will only display, distribute, or otherwise make such PowerPoint slides and images from the applicable JAMAevidence materials available to students or other persons attending in-person presentations, lectures, rounds, or other similar instructional activities presented or given by User. Commercial use of the PowerPoint slides and images are not permitted under this agreement. Users may modify the content of downloaded PowerPoint slides only for educational (non-commercial) use; however, the source and attribution may not be modified. Users may not otherwise copy, print, transmit, rent, lend, sell, or modify any images from JAMAevidence or modify or remove any proprietary notices contained therein, or create derivative works based on materials therefrom. They also may not disseminate any portion of the applicable JAMAevidence site subscribed to hereunder through electronic means except as outlined above, including mail lists or electronic bulletin boards.


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