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The NeBoP score - a clinical prediction test for evaluation of children with Lyme Neuroborreliosis in Europe

机译：NeBoP分数-用于评估欧洲莱姆病患儿的临床预测测试

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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.
机译：背景：在欧洲，莱姆病的诊断是基于临床症状和实验室数据，例如根据指南，血清和脑脊液中的细胞增多和抗Borrelia抗体。但是，入院时开始抗生素治疗的决定不能基于Borrelia血清学，因为在腰穿时尚无结果。因此，早期预测测试将在临床实践中有用。该研究的目的是在相关的欧洲环境中开发和评估针对LNB儿童的临床预测测试。方法：回顾性收集瑞典东南部一组正在评估LNB的儿童的临床和实验室数据。 NeBoP评分是一项临床神经衰弱预测测试，旨在区分患有LNB的高风险和低风险。然后在瑞典中部和东南部（n = 190）以及其他特定诊断对照（n = 49）的一组儿童中，对NeBoP分数进行前瞻性验证。结果：NeBoP评分的敏感性为90％（CI 95％； 82-99％），特异性为90％（CI 95％； 85-96％）。因此，诊断准确性（即测试如何正确区分患者与对照）为90％，ROC分析中曲线下的面积为0.95。阳性预测值（PPV）为0.83（CI 95％; 0.75-0.93），阴性预测值（NPV）为0.95（CI 95％; 0.90-0.99）。结论：NeBoP评分的总体诊断性能很高（90％），建议该测试对于欧洲莱姆病流行地区评估LNB的儿童早期抗生素治疗的决策是有用的。

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