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Enteroviral testing and length of hospital stay for children evaluated for lyme meningitis.

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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.

Copyright © 2013 Elsevier Inc. All rights reserved.

J Emerg Med. 2013 Jun;44(6):1196-200. doi: 10.1016/j.jemermed.2012.11.096. Epub 2013 Apr 12. Multicenter Study

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