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Integrating spatial epidemiology into a decision model for evaluation of facial palsy in children.

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Abstract

OBJECTIVE:

To develop a novel diagnostic algorithm for
Lyme disease among children with facial palsy by integrating public health surveillance data with traditional clinical predictors.

DESIGN:

Retrospective cohort study.

SETTING:

Children’s Hospital Boston emergency department, 1995-2007.

PATIENTS:

Two hundred sixty-four children (aged <20 years) with peripheral facial palsy who were evaluated for
Lyme disease.

MAIN OUTCOME MEASURES:

Multivariate regression was used to identify independent clinical and epidemiologic predictors of
Lyme disease facial palsy.

RESULTS:

Lyme diagnosis was positive in 65% of children from high-risk counties in Massachusetts during
Lyme disease season compared with 5% of those without both geographic and seasonal risk factors. Among patients with both seasonal and geographic risk factors, 80% with 1 clinical risk factor (fever or headache) and 100% with 2 clinical factors had
Lyme disease. Factors independently associated with
Lyme disease facial palsy were development from June to November (odds ratio, 25.4; 95% confidence interval, 8.3-113.4), residence in a county where the most recent 3-year average
Lyme disease incidence exceeded 4 cases per 100,000 (18.4; 6.5-68.5), fever (3.9; 1.5-11.0), and headache (2.7; 1.3-5.8). Clinical experts correctly treated 68 of 94 patients (72%) with
Lyme disease facial palsy, but a tool incorporating geographic and seasonal risk identified all 94 cases.

CONCLUSIONS:

Most physicians intuitively integrate geographic information into
Lyme disease management, but we demonstrate quantitatively how formal use of geographically based incidence in a clinical algorithm improves diagnostic accuracy. These findings demonstrate potential for improved outcomes from investments in health information technology that foster bidirectional communication between public health and clinical settings.

Arch Pediatr Adolesc Med. 2011 Jan;165(1):61-7. doi: 10.1001/archpediatrics.2010.250. Comparative Study; Evaluation Studies; Research Support, N.I.H., Extramural; Research Support, U.S. Gov’t, P.H.S.

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