So Just How Good Are You or Your Colleagues in the Emergency Department at Suspecting
LewisFirst, MD, MA, Editor in Chief, Pediatrics
When a patient comes in not feeling well with aches and pains maybe with or without
a fever, in tick-infested areas of the country, Lyme disease must be considered. How
good are we in our ability to estimate a high enough probability of Lyme disease to
initiate treatment before Lyme results are available? Nigrovic et al. (10.1542/peds.2017-1975) answer that question by presenting data on a prospective cohort of over a thousand
children ages 1 to 21 years evaluated for Lyme disease in 5 emergency departments.
Physicians were asked to estimate the probability of a child having Lyme on a ten
point scale and then compared their prediction to results of a child having an actual
erythema migrans lesion or positive serology. While 23% were positively diagnosed
by rash or serology, clinical suspicion was extremely poor. 12% of those whom physicians
said did not have Lyme ended up having it, and of those that had it, a third of clinicians
predicted they did not.
Does this tick you off? Regardless, rather than rely on clinical suspicion to make
the diagnosis, this study certainly suggests the use of serology to insure appropriate
and not over or under diagnosis. Do you agree? How often do you diagnose Lyme without
supportive labs and just treat? We’d love to hear your comments on the findings of
this study relative to your own practice. Share your thoughts with us via this blog,
posting a comment on our website with the article or upload a response on our Facebook
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