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 or Twitter sites.