Rule of 7s for Lyme Neuroborreliosis in Children
Clinical prediction rule for children with CSF pleocytosis (meningitis) in Lyme disease-endemic areas: a child with none of the three 'Rule of 7s' features is at low risk of Lyme meningitis and can be considered for outpatient management while Lyme serology is awaited. It needs CSF results; it was derived and validated in US endemic areas.
Score interpretation
None of the three features. Sensitivity of the rule for Lyme meningitis 96 % (5 of 130 low-risk children had it; Cohn 2012) and 98 % in the 2021 pooled validation.
→ Consider outpatient management while awaiting Lyme serology if the child is otherwise well; consider other causes of aseptic meningitis (e.g. enterovirus); safety-net advice and a plan to act on the serology result.
One or more features present: Lyme meningitis cannot be excluded (specificity of the rule 41 %).
→ Send Lyme serology and discuss with paediatric infectious diseases about starting treatment while results are awaited (NICE NG95); check doses in a children's formulary.
Interpretation bands for the Rule of 7s Lyme. Apply clinical judgement and local guidance.
References
- Garro AC, et al. Prospective validation of a clinical prediction model for Lyme meningitis in children. Pediatrics. 2009;123(5):e829–e834.
- Cohn KA, et al. Validation of a clinical prediction rule to distinguish Lyme meningitis from aseptic meningitis. Pediatrics. 2012;129(1):e46–e53.
- Garro A, et al. Validation of the Rule of 7's for identifying children at low-risk for Lyme meningitis. Pediatr Infect Dis J. 2021;40(4):306–309.
- NICE. Lyme disease. NICE guideline NG95. 2018.
Related
Curated clinical cross-links plus same-class fallbacks.
- Tick-borne encephalitis vaccine · Inactivated TBE vaccine
- Methotrexate (Dermatology — Psoriasis) · Disease-Modifying Antirheumatic / Immunosuppressant
- Valaciclovir (ENT — Ramsay Hunt / Bell's Palsy) · Antiviral (Prodrug of Aciclovir)
- Acetazolamide (Ménière's Disease) · Carbonic Anhydrase Inhibitor (Diuretic)
- Zinc acetate · Zinc salt (Wilson's disease)
- Sulfasalazine · Aminosalicylate / Disease-Modifying Antirheumatic Drug (DMARD)
- Acute Stroke / TIA Assessment · NICE NG128; RCP Stroke Guidelines 2023
- Status Epilepticus (Adults) · NICE CG137; ESEM guidelines; RCP Neurology Guidelines
- Suspected Subarachnoid Haemorrhage · NICE NG228; RCEM 2023; AHA/ASA 2023
- Adult Head Injury · NICE NG232 (2023)
- Bell's Palsy / Facial Nerve Palsy · ENT UK 2017; AAN
- Vertigo Workup · ENT UK; NICE CKS
Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.