title: Enteroviral testing and length of hospital stay for children evaluated for lyme meningitis.
abstract: BACKGROUND
  In Lyme disease-endemic areas, many children with aseptic meningitis are hospitalized while awaiting Lyme serology results. Although Lyme serology takes several days, an enteroviral polymerase chain reaction (EV PCR) test takes only a few hours to return results.
  
  
  OBJECTIVE
  Our aim was to measure the impact of EV PCR testing on duration of stay for children evaluated for Lyme meningitis.
  
  
  METHODS
  A retrospective cohort study was performed with children evaluated for Lyme meningitis at 3 Emergency Departments located in Lyme disease-endemic areas. We defined Lyme meningitis using the Centers for Disease Control and Prevention criteria (either positive Lyme serology test result or an erythema migrans rash). The duration of stay was compared by EV PCR test result (positive, negative, and not obtained).
  
  
  RESULTS
  There were 423 study patients identified, 117 (28%) of whom had Lyme meningitis and 209 (49%) had an EV PCR test performed. Median length of stay varied by the EV PCR test status: children with a positive EV PCR test (n = 103; 28 h; interquartile range 17-48 h), those with a negative EV PCR test (n = 106; 72 h; interquartile range 48-120 h), and those who did not have an EV PCR test obtained (n = 214; 48 h; interquartile range 24-96 h; p ≤ 0.001).
  
  
  CONCLUSIONS
  Rapid EV PCR testing could assist clinical decision making by Emergency Physicians, avoiding potentially unnecessary hospitalization and parenteral antibiotics for children at low risk of Lyme meningitis.
authors.affiliation: Division of Emergency Medicine, Boston Children's Hospital, Boston, MA 02115, USA.
authors.forename: Lise E
authors.initials: LE
authors.lastname: Nigrovic
authors.forename: Keri A
authors.initials: KA
authors.lastname: Cohn
authors.forename: Todd W
authors.initials: TW
authors.lastname: Lyons
authors.forename: Amy D
authors.initials: AD
authors.lastname: Thompson
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: Hines
authors.forename: Elizabeth J
authors.initials: EJ
authors.lastname: Welsh
authors.forename: Samir S
authors.initials: SS
authors.lastname: Shah
mesh_terms: D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003937:Diagnosis, Differential; D004636:Emergency Service, Hospital; D019353:Endemic Diseases; D004770:Enterovirus / Q000302:isolation & purification*; D004769:Enterovirus Infections / Q000175:diagnosis; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008193:Lyme Disease / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology; D008297:Male; D008582:Meningitis, Aseptic / Q000175:diagnosis*; D016920:Meningitis, Bacterial / Q000175:diagnosis* / Q000188:drug therapy; D016133:Polymerase Chain Reaction; D012189:Retrospective Studies
chemical_list: D000900:Anti-Bacterial Agents