Integrating Spatial Epidemiology Into a Decision Model for Evaluation of Facial Palsy in Children
Open Access
- 1 January 2011
- journal article
- research article
- Published by American Medical Association (AMA) in Archives of Pediatrics & Adolescent Medicine
- Vol. 165 (1), 61-67
- https://doi.org/10.1001/archpediatrics.2010.250
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 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.Keywords
This publication has 36 references indexed in Scilit:
- Use of population health data to refine diagnostic decision-making for pertussisJournal of the American Medical Informatics Association, 2010
- Clinical Predictors of Lyme Disease Among Children With a Peripheral Facial Palsy at an Emergency Department in a Lyme Disease–Endemic AreaPublished by American Academy of Pediatrics (AAP) ,2008
- The Clinical Assessment, Treatment, and Prevention of Lyme Disease, Human Granulocytic Anaplasmosis, and Babesiosis: Clinical Practice Guidelines by the Infectious Diseases Society of AmericaClinical Infectious Diseases, 2006
- Effects of Climate on Variability in Lyme Disease Incidence in the Northeastern United StatesAmerican Journal of Epidemiology, 2003
- Lyme DiseaseNew England Journal of Medicine, 2001
- Risk Factors for Cerebral Edema in Children with Diabetic KetoacidosisNew England Journal of Medicine, 2001
- Clinical Prediction RulesA Review and Suggested Modifications of Methodological StandardsJAMA, 1997
- Chart Reviews In Emergency Medicine Research: Where Are The Methods?Annals of Emergency Medicine, 1996
- Recommendations for test performance and interpretation from the Second National Conference on Serologic Diagnosis of Lyme Disease.1995
- Differential diagnosis and the competing-hypotheses heuristic. A practical approach to judgment under uncertainty and Bayesian probability.1985