Prediction of aseptic meningitis among patients
with fever and headache
Hiroaki Takeoka 1)※ Ken Horibata 1) Kazuhiko Ajisaka 1) Eishi Sakihara 1)
Hiroki Suzuyama 1) Tetsuya Hiyoshi 1) Hisatomi Arima 2) Shigeki Nabeshima 1)
1) General Medicine, Fukuoka University Hospital
2) Department of Preventive Medicine and Public Health, Fukuoka University
Key Words：meningitis, vomiting, Jolt accentuation, C-reactive protein, risk prediction
[Objective] Meningitis, especially aseptic meningitis, is frequently encountered in outpatient clinics. Lumbar puncture is commonly used to confirm a diagnosis of meningitis. In this hospitalbased observational study, we retrospectively investigated the medical records of patients with fever and headache to determine the clinical features of meningitis and clarify the role of lumbar puncture in diagnosis.
[Methods] Out of 189 patients with fever and headache as the chief complaints, the data of 103 patients with aseptic meningitis was compared with that of 86 patients with other diseases.
[Results] Age 30 years and over, time from first symptoms to medical examination more than six days, vomiting, Jolt accentuation and C-reactive protein (CRP) less than 3.0 were associated with meningitis. In the analysis of a scoring system, we developed based on these parameters, meningitis was more likely with a score of four or higher on the seven points scale, thus lumbar puncture should be considered for patients with scores of four or more.
[Conclusions] Based on the five identified risk factors, lumbar puncture should be considered if the score is 4 or higher on our new scoring system for meningitis, which would be useful as a diagnostic tool for aseptic meningitis.