Meningitis: a stiff back or neck increased the chance of survival

Clinical bottom line (level 1b)

  1. A third of elderly patients with bacterial meningitis died.
  2. Patients with a stiff back or neck were more likely to survive.
Rasmussen et al: Age and Ageing 1992; 21: 216-220
Expires November 2003

The study

Prospective cohort study with objective outcomes, adjusted for confounding factors, not validated in an independent set of patients.

Setting: 2 acute hospitals, Denmark

48 patients (aged 60 to 88; median 69, 65% female) with acute bacterial meningitis (diagnosed on CSF culture, microscopy; autopsy; or pleocytosis with features of meningitis)

Excluded if
  • <60 years old



    • Factors studied:
  • clinical features (fever, hypotension, nausea, vomiting, headache) and aetiology
  • neck or back stiffness




    • Logistic regression analysis was performed to adjust for confounding factors.

    ?100% followed for length of hospital stay
    Outcomes studied:
  • survival

    • The evidence

    outcome time to outcome number of patients/total number %
    (95% CI)
    survival length of hospital stay 30/48 63%
    (49% to 76%)

    prognostic factor for
    survival     		time to outcome control rate (%) adjusted OR
    (95% CI)    		 NNF+
    (95% CI)
    neck or back stiffness ? 30/48
    (62.5%)     		4.0
    (1.1 to 14.3)     		4
    (3 to 45)

    Comments

    1. 33% of cases were caused by Strep pneumonia; 10% by N. meningitidis, 13% by TB and 29% of cases were unknown.

    Citation

    1. Rasmussen HH, Sorensen HT, Moller-Petersen J, et al: bacterial meningitis in elderly patients: clinical picture and course. Age and Ageing 1992; 21: 216-220
    Search Terms: ?
    Contributor: Chris Ball and Clare Wotton, November 1999
    Reviewer:

    Clinical Question.
    Patient elderly with bacterial meningitis
    Intervention or Exposure clinical features
    Outcome death