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Prospective validation of a clinical prediction model for Lyme meningitis in children.
Pediatrics. 2009 May; 123(5):e829-34.Ped

Abstract

OBJECTIVE

Lyme meningitis is difficult to differentiate from other causes of aseptic meningitis in Lyme disease-endemic regions. Parenteral antibiotics are indicated for Lyme meningitis but not viral causes of aseptic meningitis. A clinical prediction model was developed to distinguish Lyme meningitis from other causes of aseptic meningitis. Our objective was to prospectively validate this model.

METHODS

Children between 2 and 18 years of age presenting to Hasbro Children's Hospital from April through October of 2006 and 2007 were enrolled if a lumbar puncture for meningitis showed a cerebrospinal fluid white blood cell count of >8 cells per microL. Cerebrospinal fluid was sent for Lyme antibody testing. The probability of Lyme meningitis was calculated by using the percentage of cerebrospinal fluid mononuclear cells, duration of headache, and presence of cranial neuropathy by using the prediction model. Definite Lyme meningitis cases were defined as cerebrospinal fluid pleocytosis with (1) positive Lyme serology confirmed by immunoblot or (2) erythema migrans rash. Possible Lyme meningitis cases were defined as cerebrospinal fluid pleocytosis with positive cerebrospinal fluid Lyme antibody. Sensitivity, specificity, and likelihood ratios for definite and possible Lyme meningitis were determined by using 10% increments of calculated probability of Lyme meningitis.

RESULTS

Fifty children were enrolled, including 14 children with definite Lyme meningitis, 6 with possible Lyme meningitis, and 30 with aseptic meningitis. A calculated probability of <10% for Lyme meningitis had a negative likelihood ratio of 0.006 for definite and possible Lyme meningitis cases. A calculated probability of >50% for Lyme meningitis had a positive likelihood ratio of 100 using these definitions.

CONCLUSIONS

A clinical prediction model using the percentage of cerebrospinal fluid mononuclear cells, headache duration, and presence of cranial neuropathy can differentiate children with Lyme meningitis from children with aseptic meningitis. Our findings suggest categories of low (<10%), indeterminate (10%-50%), and high (>50%) probability of Lyme meningitis.

Authors+Show Affiliations

Rhode Island Hospital, Pediatric Emergency Medicine, Claverick Building, 2nd Floor, Providence, RI 02906, USA. agarro@lifespan.orgNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't
Validation Study

Language

eng

PubMed ID

19403476

Citation

Garro, Aris C., et al. "Prospective Validation of a Clinical Prediction Model for Lyme Meningitis in Children." Pediatrics, vol. 123, no. 5, 2009, pp. e829-34.
Garro AC, Rutman M, Simonsen K, et al. Prospective validation of a clinical prediction model for Lyme meningitis in children. Pediatrics. 2009;123(5):e829-34.
Garro, A. C., Rutman, M., Simonsen, K., Jaeger, J. L., Chapin, K., & Lockhart, G. (2009). Prospective validation of a clinical prediction model for Lyme meningitis in children. Pediatrics, 123(5), e829-34. https://doi.org/10.1542/peds.2008-2048
Garro AC, et al. Prospective Validation of a Clinical Prediction Model for Lyme Meningitis in Children. Pediatrics. 2009;123(5):e829-34. PubMed PMID: 19403476.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Prospective validation of a clinical prediction model for Lyme meningitis in children. AU - Garro,Aris C, AU - Rutman,Maia, AU - Simonsen,Kari, AU - Jaeger,Jenifer L, AU - Chapin,Kimberle, AU - Lockhart,Gregory, PY - 2009/5/1/entrez PY - 2009/5/1/pubmed PY - 2009/5/27/medline SP - e829 EP - 34 JF - Pediatrics JO - Pediatrics VL - 123 IS - 5 N2 - OBJECTIVE: Lyme meningitis is difficult to differentiate from other causes of aseptic meningitis in Lyme disease-endemic regions. Parenteral antibiotics are indicated for Lyme meningitis but not viral causes of aseptic meningitis. A clinical prediction model was developed to distinguish Lyme meningitis from other causes of aseptic meningitis. Our objective was to prospectively validate this model. METHODS: Children between 2 and 18 years of age presenting to Hasbro Children's Hospital from April through October of 2006 and 2007 were enrolled if a lumbar puncture for meningitis showed a cerebrospinal fluid white blood cell count of >8 cells per microL. Cerebrospinal fluid was sent for Lyme antibody testing. The probability of Lyme meningitis was calculated by using the percentage of cerebrospinal fluid mononuclear cells, duration of headache, and presence of cranial neuropathy by using the prediction model. Definite Lyme meningitis cases were defined as cerebrospinal fluid pleocytosis with (1) positive Lyme serology confirmed by immunoblot or (2) erythema migrans rash. Possible Lyme meningitis cases were defined as cerebrospinal fluid pleocytosis with positive cerebrospinal fluid Lyme antibody. Sensitivity, specificity, and likelihood ratios for definite and possible Lyme meningitis were determined by using 10% increments of calculated probability of Lyme meningitis. RESULTS: Fifty children were enrolled, including 14 children with definite Lyme meningitis, 6 with possible Lyme meningitis, and 30 with aseptic meningitis. A calculated probability of <10% for Lyme meningitis had a negative likelihood ratio of 0.006 for definite and possible Lyme meningitis cases. A calculated probability of >50% for Lyme meningitis had a positive likelihood ratio of 100 using these definitions. CONCLUSIONS: A clinical prediction model using the percentage of cerebrospinal fluid mononuclear cells, headache duration, and presence of cranial neuropathy can differentiate children with Lyme meningitis from children with aseptic meningitis. Our findings suggest categories of low (<10%), indeterminate (10%-50%), and high (>50%) probability of Lyme meningitis. SN - 1098-4275 UR - https://www.unboundmedicine.com/medline/citation/19403476/Prospective_validation_of_a_clinical_prediction_model_for_Lyme_meningitis_in_children_ L2 - http://pediatrics.aappublications.org/cgi/pmidlookup?view=long&amp;pmid=19403476 DB - PRIME DP - Unbound Medicine ER -