title: The NeBoP score - a clinical prediction test for evaluation of children with Lyme Neuroborreliosis in Europe.
abstract: 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.
  
  
  METHODS
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Paediatric clinic, Falun General Hospital, Nissers väg 3, S-791 82, Falun, Sweden. barbro.hedinskogman@ltdalarna.se.|Center for Clinical Research (CKF) Dalarna-Uppsala University, S-791 31, Falun, Sweden. barbro.hedinskogman@ltdalarna.se.
authors.forename: Barbro H
authors.initials: BH
authors.lastname: Skogman
authors.affiliation: Clinic of Infectious Diseases, Linköping University Hospital, S-581 85, Linköping, Sweden. johanna.sjowall@liu.se.
authors.forename: Johanna
authors.initials: J
authors.lastname: Sjöwall
authors.affiliation: Department of Clinical and Experimental Medicine, Medical Microbiology, Linköping University, S-581 85, Linköping, Sweden. per-eric.lindgren@liu.se.|Microbiological Laboratory, Medical Services, County Hospital Ryhov, S-551 85, Jönköping, Sweden. per-eric.lindgren@liu.se.
authors.forename: Per-Eric
authors.initials: PE
authors.lastname: Lindgren
mesh_terms: D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D000066491:Clinical Decision-Making; D003661:Decision Support Techniques; D019353:Endemic Diseases; D005260:Female; D006801:Humans; D007223:Infant; D020852:Lyme Neuroborreliosis / Q000175:diagnosis* / Q000188:drug therapy; D008297:Male; D012189:Retrospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D013548:Sweden; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents