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Does This Adult Patient Have Acute Meningitis?

Does This Adult Patient Have Acute Meningitis?. 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.

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Does This Adult Patient Have Acute Meningitis?

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  1. Does This Adult Patient Have Acute Meningitis?

  2. 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. LR: Impact on Likelihood of Disease LR = 0.01 Less Likely LR = 100 More Likely LR = 0.1 Less Likely LR = 10 More Likely LR = 0.2 Less Likely LR = 5 More Likely LR = 0.3 Less Likely LR = 3 More Likely 0  Increasing impact increasing impact LR = 1 No Impact on Likelihood of Disease

  4. Test Characteristics: Examination Likelihood Ratios From Prospective Studies

  5. Likelihood Ratio Jolt accentuation test LR– = 0.05 If negative, posttest probability < 0.1% Jolt accentuation test LR+ = 2.4 1% Pretest probability in population presenting to ED If positive, posttest probability = 2%

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