Article Figures & Data
Tables
- Table 1.
Appropriate and Inappropriate Indications For Lyme Disease Serologic Testing in Lyme-Endemic Regions
Appropriate Inappropriate Note: If patient does not meet any of the above criteria for appropriateness, the decision to order a Lyme disease serologic test is left to the discretion of the clinician. Patient with oligoarticular arthritis Patient is asymptomatic Patient with cranial neuritis Patient with clinician-diagnosed erythema migrans Patient with lymphocytic meningitis Patient treated empirically with antibiotics Patient with atrioventricular block Serologic test ordered as a test of cure Patient with carditis - Table 2.
The Number of Appropriate, Inappropriate and Discretionary Lyme Disease Serologic Test Requests by Clinical Specialty and by Source of Test Initiation
Characteristic No. Appropriate No. (%) Inappropriate No. (%) Discretionary No. (%) Clinical specialty Family practice 151 30 (20) 35 (23) 86 (57) Internal medicine 67 12 (18) 21 (31) 34 (51) Emergency or urgent care 32 4 (13) 15 (47) 13 (41) Pediatrics 23 2 (9) 5 (22) 16 (70) Neurology 19 6 (32) 2 (11) 11 (58) Rheumatology 8 6 (75) 1 (13) 1 (13) Others 56 12 (21) 16 (29) 28 (50) Total 356 72 (20) 95 (27) 189 (53) Initiation of testing Clinician initiated 218 60 (28) 47 (22) 111 (51) Patient initiated 95 8 (8) 37 (39) 50 (53) Not clear 43 4 (9) 11 (26) 28 (65) Total 356 72 (20) 95 (27) 189 (53) - Table 3.
Results of Univariate and Stepwise Multivariate Unconditional Logistic Regression Model Analysis for Factors Associated With Inappropriate Lyme Disease Serologic Testing
Variable Univariate COR (95% CI) Multivariate AOR (95% CI) COR = crude odds ratio; AOR = adjusted odds ratio; CI = confidence interval. Note: discretionary tests were excluded from this analysis. Known or suspected tick bite within 30 days of symptom onset 6.9 (2.9–16.5) 6.8 (2.6–17.6) Test ordered by emergency or urgent care physician 3.7 (1.2–11.4) 5.2 (1.3–20.6) Test initiated by patient request 5.8 (2.5–13.6) Test done during summer 2.5 (1.3–4.7) Patient age less than 40 years 1.6 (0.8–3.0) Initial evaluation of problem for which test was ordered 1.5 (0.8–3.1) Test done at Laboratory A 1.1 (0.4–2.9) Test ordered by physician 0.9 (0.4–2.3) Clinician in practice less than 10 years 1.0 (0.5–1.8) Tick habitat exposure during last 30 days 0.6 (0.1–3.1) Patient hospitalized 0.3 (0.1–1.0) Patient referred from another clinician 0.3 (0.1–0.6)
Additional Files
The Article in Brief
Each year, approximately 2.8 million tests are done in the United States to detect Lyme disease, a bacterial infection spread by ticks. Early testing based on a tick bite or potential exposure to ticks is often not effective or accurate. A recent study found that 20% of Lyme disease tests were appropriate and at least 27% were not appropriate. In more than one half of the inappropriate tests, the patient did not show symptoms of the disease. Most inappropriate tests were initiated by physicians. Almost 40% of the tests requested by patients were inappropriate.
