title: Lyme disease testing in children in an endemic area.
abstract: OBJECTIVE
  The purpose of this study was to determine clinician adherence to recommendations regarding diagnostic testing for Lyme disease (LD). The specific aims were to determine the rate of inappropriate test ordering for a diagnosis of erythema migrans and tack of confirmatory test ordering for positive LD screening tests.
  
  
  METHODS
  Using the data warehouse of Marshfield Clinic Research Foundation's Bioinformatics Research Center, cases were identified from 2002 through 2007. A retrospective chart abstraction was performed using Marshfield Clinic's electronic medical record. The study involved children (<19 years old).
  
  
  RESULTS
  In 57% of cases, LD testing occurred after a clinical diagnosis of erythema migrans was made. Patients with any symptom in addition to erythema migrans were more likely to have testing (odds ratio (OR) = 3.52, 1.75-7.08). A positive LD screening test was not confirmed 24% of the time. Lack of ordering confirmatory testing was not associated with any clinical factors or site of the evaluation.
  
  
  CONCLUSIONS
  This study found that some clinicians in an LD-endemic area do not follow guidelines for diagnosing children suspected to have Lyme disease.
authors.affiliation: Department of Infectious Medicine, Marshfield Clinic, Marshfield, Wisconsin 54449, USA.
authors.forename: Bashar
authors.initials: B
authors.lastname: Al-Sharif
authors.forename: Matthew C
authors.initials: MC
authors.lastname: Hall
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003937:Diagnosis, Differential; D019353:Endemic Diseases; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D007223:Infant; D008193:Lyme Disease / Q000175:diagnosis* / Q000453:epidemiology*; D008297:Male; D012189:Retrospective Studies; D019564:Unnecessary Procedures; D014922:Wisconsin / Q000453:epidemiology