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Published on: February 14, 2011
Towards harmonization of Lyme diagnostics interpretation: external quality assessment using a web-based survey
B J A Hoeve-Bakker1,2, K Kerkhof3, A P van Dam4
1Centre for Infectious Disease Control (CIb), National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands. dieneke.hoeve@rivm.nl.
Background:
Laboratory testing plays an important role in diagnosis and clinical management of Lyme borreliosis (LB). While external quality assessments (EQAs) evaluate the technical quality of laboratory diagnostics, the clinical interpretation of laboratory results often remains unassessed. Although specific guidelines are available, different interpretation can result in variations in clinical diagnosis and subsequent management of LB patients. This study aimed to evaluate variations in interpretating LB laboratory diagnostics in relation to the clinical history of the patient.
Methods:
An EQA was organized for medical microbiological laboratories (MMLs) in the Netherlands using a web-based survey. The survey consisted of twenty LB case descriptions including laboratory findings. Participants were asked to (i) interpret each case according to their protocols (open-ended), and (ii) rate the likelihood of the case being active LB (multiple-choice). Six LB diagnostics experts determined the baseline and scored participants' answers on a 1-10 scale.
Results:
Of the 50 invited MMLs, 38 (76.0%) completed the survey. The overall mean score was 8.8 (range: 7.2 - 9.8). For the multiple-choice questions, the mean score was 9.6 (range: 8.4 - 10) and for open-ended questions this was 8.0 (range: 5.6 - 9.6). Lower scores were obtained for low-incidence manifestations.
Conclusions:
This EQA showed that interpreting LB laboratory results in relation to the clinical information was good and increased awareness among participants to challenges of LB diagnosis and treatment. Training and education could improve interpretation skills. This EQA might be exemplary for future harmonization efforts for (pan-European) clinical evaluation of LB diagnostics. As a potential future approach, supplementing guidelines with an artificial intelligence-based clinical support system could aid medical microbiologists and physicians in decision making, especially for rare manifestations.
