HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) In Brief TRACK Comments: Submit a response TRACK Comments: View responses Alert me when this article is cited Alert me when TRACK Comments are posted Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Ramsey, A. H. Articles by Davis, J. P. Search for Related Content PubMed PubMed Citation Articles by Ramsey, A. H. Articles by Davis, J. P.

Appropriateness of Lyme Disease Serologic Testing

¹ Bureau of Communicable Diseases, Wisconsin Division of Public Health, Madison, Wis
² Epidemic Intelligence Service, Division of Applied Public Health Training, Epidemiology Program Office, Centers for Disease Control and Prevention, Atlanta, Ga
³ Marshfield Clinic Research Foundation, Marshfield Clinic, Marshfield, Wis

CORRESPONDING AUTHOR: Edward A. Belongia, MD, Epidemiology Research Center, Marshfield Clinic Research Foundation, 1000 N. Oak Ave., Marshfield, WI 54449, belongia.edward{at}mmrf.mfldclin.edu

BACKGROUND Although rapid diagnosis of Lyme disease is essential for effective treatment, there is concern about inappropriate testing. We conducted a prospective, cross-sectional survey of clinicians to assess the use and appropriateness of Lyme disease serologic tests (LDSTs).

METHODS LDSTs performed at 2 large Wisconsin reference laboratories were systematically sampled for 12 consecutive months. A standardized questionnaire was used to gather data about the submitting clinician and the patient tested. Tests were categorized as appropriate, inappropriate, or discretionary, and associations were assessed using logistic regression analysis. A test was defined as inappropriate if the patient was asymptomatic, had erythema migrans, or was treated empirically, or if the test was ordered as a test of cure.

RESULTS We surveyed 303 clinicians regarding 356 LDSTs: 72 tests (20%) were appropriate, 95 (27%) were inappropriate, and 189 (53%) were discretionary. Tests were more likely to be inappropriate if they were ordered by an emergency or urgent care physician compared with other specialists (adjusted odds ratio [AOR] 5.2, 95% confidence interval [CI], 1.3–20.6), or if preceded by a known tick bite (AOR 6.8, 95% CI, 2.6–17.6). The patient rather than the clinician requested 26% of tests, which were more likely to be inappropriate than clinician-requested tests (crude odds ratio [COR] 5.8, 95% CI, 2.5–13.6). Tests were more likely to be patient-requested if they were ordered by an internist (AOR 2.6, 95% CI, 1.4–4.8) or if the patient was 40 years old (AOR 2.2, 95% CI, 1.3–3.9).

CONCLUSIONS Many LDSTs are ordered inappropriately, often influenced by patient demand. Education of clinicians and patients about testing indications and contraindications is needed to reduce the number of inappropriate LDSTs.

Key Words: Lyme disease • serologic tests/utilization • Borrelia burgdorferi

This article has been cited by other articles:

				K. C. Stange Questions, Interpretation, Exhortation Ann. Fam. Med, September 1, 2004; 2(5): 514 - 517. [Full Text] [PDF]

				K. C. Stange In This Issue: Practice Change and Patient Safety Ann. Fam. Med, July 1, 2004; 2(4): 290 - 291. [Full Text] [PDF]

TRACK Comments: