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Although Lyme disease is the most common cause of acquired facial palsy in children, the decision to initiate antibiotic or steroid therapy in the emergency department must be made before confirmatory serology results are known. To identify predictors of Lyme disease as the etiology of facial palsy, investigators retrospectively reviewed laboratory and clinical data for all 420 children (age, <20 years) who presented with peripheral facial palsy to a single ED in a Lyme disease–endemic area during a 12-year period. Patients who met the CDC clinical definition of Lyme disease and had positive Western blot serology were considered positive for Lyme disease.
Of 313 children who were tested for Lyme disease during the ED evaluation, 106 (34%) we…