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Validation of a clinical prediction rule to distinguish Lyme meningitis from aseptic meningitis.
Pediatrics. 2012 Jan; 129(1):e46-53.Ped

Abstract

OBJECTIVES

The "Rule of 7's," a Lyme meningitis clinical prediction rule, classifies children at low risk for Lyme meningitis when each of the following 3 criteria are met: <7 days of headache, <70% cerebrospinal fluid (CSF) mononuclear cells, and absence of seventh or other cranial nerve palsy. The goal of this study was to test the performance of the Rule of 7's in a multicenter cohort of children with CSF pleocytosis.

METHODS

We performed a retrospective cohort study of children evaluated at 1 of 3 emergency departments located in Lyme disease-endemic areas with CSF pleocytosis and Lyme serology obtained. Lyme meningitis was defined using the Centers for Disease Control and Prevention criteria (either positive Lyme serology test result or an erythema migrans [EM] rash). We calculated the performance of the Rule of 7's in our overall study population and in children without physician-documented EM.

RESULTS

We identified 423 children, of whom 117 (28% [95% confidence interval (CI): 24%-32%]) had Lyme meningitis, 306 (72% [95% CI: 68%-76%]) had aseptic meningitis, and 0 (95% CI: 0%-1%) had bacterial meningitis. Of the 130 classified as low risk, 5 had Lyme meningitis (sensitivity, 112 of 117 [96% (95% CI: 90%-99%)]; specificity, 125 of 302 [41% (95% CI: 36%-47%)]). In the 390 children without EM, 3 of the 127 low-risk patients had Lyme meningitis (2% [95% CI: 0%-7%]).

CONCLUSIONS

Patients classified as low risk by using the Rule of 7's were unlikely to have Lyme meningitis and could be managed as outpatients while awaiting results of Lyme serology tests.

Authors+Show Affiliations

Division of Emergency Medicine, Children's Hospital and Harvard Medical School, Boston 300 Longwood Ave, Boston, MA 02115, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Multicenter Study
Validation Study

Language

eng

PubMed ID

22184651

Citation

Cohn, Keri A., et al. "Validation of a Clinical Prediction Rule to Distinguish Lyme Meningitis From Aseptic Meningitis." Pediatrics, vol. 129, no. 1, 2012, pp. e46-53.
Cohn KA, Thompson AD, Shah SS, et al. Validation of a clinical prediction rule to distinguish Lyme meningitis from aseptic meningitis. Pediatrics. 2012;129(1):e46-53.
Cohn, K. A., Thompson, A. D., Shah, S. S., Hines, E. M., Lyons, T. W., Welsh, E. J., & Nigrovic, L. E. (2012). Validation of a clinical prediction rule to distinguish Lyme meningitis from aseptic meningitis. Pediatrics, 129(1), e46-53. https://doi.org/10.1542/peds.2011-1215
Cohn KA, et al. Validation of a Clinical Prediction Rule to Distinguish Lyme Meningitis From Aseptic Meningitis. Pediatrics. 2012;129(1):e46-53. PubMed PMID: 22184651.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Validation of a clinical prediction rule to distinguish Lyme meningitis from aseptic meningitis. AU - Cohn,Keri A, AU - Thompson,Amy D, AU - Shah,Samir S, AU - Hines,Elizabeth M, AU - Lyons,Todd W, AU - Welsh,Elizabeth J, AU - Nigrovic,Lise E, Y1 - 2011/12/19/ PY - 2011/12/21/entrez PY - 2011/12/21/pubmed PY - 2012/2/15/medline SP - e46 EP - 53 JF - Pediatrics JO - Pediatrics VL - 129 IS - 1 N2 - OBJECTIVES: The "Rule of 7's," a Lyme meningitis clinical prediction rule, classifies children at low risk for Lyme meningitis when each of the following 3 criteria are met: <7 days of headache, <70% cerebrospinal fluid (CSF) mononuclear cells, and absence of seventh or other cranial nerve palsy. The goal of this study was to test the performance of the Rule of 7's in a multicenter cohort of children with CSF pleocytosis. METHODS: We performed a retrospective cohort study of children evaluated at 1 of 3 emergency departments located in Lyme disease-endemic areas with CSF pleocytosis and Lyme serology obtained. Lyme meningitis was defined using the Centers for Disease Control and Prevention criteria (either positive Lyme serology test result or an erythema migrans [EM] rash). We calculated the performance of the Rule of 7's in our overall study population and in children without physician-documented EM. RESULTS: We identified 423 children, of whom 117 (28% [95% confidence interval (CI): 24%-32%]) had Lyme meningitis, 306 (72% [95% CI: 68%-76%]) had aseptic meningitis, and 0 (95% CI: 0%-1%) had bacterial meningitis. Of the 130 classified as low risk, 5 had Lyme meningitis (sensitivity, 112 of 117 [96% (95% CI: 90%-99%)]; specificity, 125 of 302 [41% (95% CI: 36%-47%)]). In the 390 children without EM, 3 of the 127 low-risk patients had Lyme meningitis (2% [95% CI: 0%-7%]). CONCLUSIONS: Patients classified as low risk by using the Rule of 7's were unlikely to have Lyme meningitis and could be managed as outpatients while awaiting results of Lyme serology tests. SN - 1098-4275 UR - https://www.unboundmedicine.com/medline/citation/22184651/Validation_of_a_clinical_prediction_rule_to_distinguish_Lyme_meningitis_from_aseptic_meningitis_ L2 - http://pediatrics.aappublications.org/cgi/pmidlookup?view=long&amp;pmid=22184651 DB - PRIME DP - Unbound Medicine ER -