Accuracy of Clinician Suspicion of Lyme Disease in the Emergency Department. Pediatrics 2017 Dec;140(6)
Date
11/28/2017Pubmed ID
29175973Pubmed Central ID
PMC5703778DOI
10.1542/peds.2017-1975Scopus ID
2-s2.0-85037686188 (requires institutional sign-in at Scopus site) 22 CitationsAbstract
BACKGROUND: To make initial management decisions, clinicians must estimate the probability of Lyme disease before diagnostic test results are available. Our objective was to examine the accuracy of clinician suspicion for Lyme disease in children undergoing evaluation for Lyme disease.
METHODS: We assembled a prospective cohort of children aged 1 to 21 years who were evaluated for Lyme disease at 1 of the 5 participating emergency departments. Treating physicians were asked to estimate the probability of Lyme disease (on a 10-point scale). We defined a Lyme disease case as a patient with an erythema migrans lesion or positive 2-tiered serology results in a patient with compatible symptoms. We calculated the area under the curve for the receiver operating curve as a measure of the ability of clinician suspicion to diagnose Lyme disease.
RESULTS: We enrolled 1021 children with a median age of 9 years (interquartile range, 5-13 years). Of these, 238 (23%) had Lyme disease. Clinician suspicion had a minimal ability to discriminate between children with and without Lyme disease: area under the curve, 0.75 (95% confidence interval, 0.71-0.79). Of the 554 children who the treating clinicians thought were unlikely to have Lyme disease (score 1-3), 65 (12%) had Lyme disease, and of the 127 children who the treating clinicians thought were very likely to have Lyme disease (score 8-10), 39 (31%) did not have Lyme disease.
CONCLUSIONS: Because clinician suspicion had only minimal accuracy for the diagnosis of Lyme disease, laboratory confirmation is required to avoid both under- and overdiagnosis.
Author List
Nigrovic LE, Bennett JE, Balamuth F, Levas MN, Chenard RL, Maulden AB, Garro AC, for Pedi Lyme NetAuthor
Michael Levas MD Professor in the Pediatrics department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
AdolescentChild
Child, Preschool
Clinical Competence
Diagnosis, Differential
Emergency Service, Hospital
Female
Humans
Infant
Lyme Disease
Male
Prospective Studies
Reproducibility of Results
Young Adult
