Low Accuracy of Clinician Suspicion for Lyme Disease

To assess the accuracy of clinician's suspicion of Lyme disease, researchers followed a cohort of children aged 1 to 21 years undergoing evaluation for Lyme disease at five emergency departments in endemic areas.

Children were eligible if they had an erythema migrans lesion or the clinician ordered Lyme disease serology. Before serology results were available, the clinician estimated the likelihood of Lyme disease on a 10-point scale. The disease was diagnosed if the child had positive serology or clinical signs compatible with Lyme disease: erythema migrans lesion; early disseminated disease (cranial neuritis, headache and/or neck pain or stiffness, electrocardiogram changes consistent with carditis); or late disease (arthritis). Patients w…