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The NeBoP score - a clinical prediction test for evaluation of children with Lyme Neuroborreliosis in Europe
Falun Gen Hospital, Sweden; Uppsala University, Sweden.
Linköping University, Department of Clinical and Experimental Medicine, Division of Microbiology and Molecular Medicine. Region Östergötland, Heart and Medicine Center, Department of Infectious Diseases. Linköping University, Faculty of Medicine and Health Sciences.
Linköping University, Department of Clinical and Experimental Medicine, Division of Microbiology and Molecular Medicine. Linköping University, Faculty of Medicine and Health Sciences. County Hospital Ryhov, Sweden.
2015 (English)In: BMC Pediatrics, ISSN 1471-2431, E-ISSN 1471-2431, Vol. 15, no 214Article in journal (Refereed) Published
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Text
Abstract [en]

Background: The diagnosis of Lyme neuroborreliosis (LNB) in Europe is based on clinical symptoms and laboratory data, such as pleocytosis and anti-Borrelia antibodies in serum and CSF according to guidelines. However, the decision to start antibiotic treatment on admission cannot be based on Borrelia serology since results are not available at the time of lumbar puncture. Therefore, an early prediction test would be useful in clinical practice. The aim of the study was to develop and evaluate a clinical prediction test for children with LNB in a relevant European setting. Method: Clinical and laboratory data were collected retrospectively from a cohort of children being evaluated for LNB in Southeast Sweden. A clinical neuroborreliosis prediction test, the NeBoP score, was designed to differentiate between a high and a low risk of having LNB. The NeBoP score was then prospectively validated in a cohort of children being evaluated for LNB in Central and Southeast Sweden (n = 190) and controls with other specific diagnoses (n = 49). Results: The sensitivity of the NeBoP score was 90 % (CI 95 %; 82-99 %) and the specificity was 90 % (CI 95 %; 85-96 %). Thus, the diagnostic accuracy (i.e. how the test correctly discriminates patients from controls) was 90 % and the area under the curve in a ROC analysis was 0.95. The positive predictive value (PPV) was 0.83 (CI 95 %; 0.75-0.93) and the negative predictive value (NPV) was 0.95 (CI 95 %; 0.90-0.99). Conclusion: The overall diagnostic performance of the NeBoP score is high (90 %) and the test is suggested to be useful for decision-making about early antibiotic treatment in children being evaluated for LNB in European Lyme endemic areas.

Place, publisher, year, edition, pages
BIOMED CENTRAL LTD , 2015. Vol. 15, no 214
Keyword [en]
Lyme neuroborreliosis; Lyme borreliosis; Predictive test; Diagnostic accuracy; Children
National Category
Clinical Medicine
Identifiers
URN: urn:nbn:se:liu:diva-124126DOI: 10.1186/s12887-015-0537-yISI: 000366968200001PubMedID: 26678681OAI: oai:DiVA.org:liu-124126DiVA: diva2:896852
Note

Funding Agencies|Center of Clinical Research Dalarna (CKF); Swedish Society of Medicine; Research Council in the Uppsala-Orebro region (RFR); Samaritan Foundation; Lions Foundation

Available from: 2016-01-22 Created: 2016-01-19 Last updated: 2017-11-30

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Sjöwall, JohannaLindgren, Per-Eric

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