Towards harmonization of Lyme diagnostics interpretation: external quality assessment using a web-based survey

Area of Science:

• Medical Microbiology
• Infectious Diseases
• Clinical Diagnostics

Background:

• Laboratory testing is crucial for diagnosing and managing Lyme borreliosis (LB).
• External quality assessments (EQAs) typically evaluate technical performance, not clinical interpretation of LB diagnostics.
• Variations in interpreting LB lab results alongside clinical history can affect patient diagnosis and management.

Purpose of the Study:

• To evaluate variations in the interpretation of Lyme borreliosis laboratory diagnostics when considered with patient clinical history.
• To assess the clinical interpretation aspect of LB laboratory diagnostics through an EQA.

Main Methods:

• An external quality assessment (EQA) was conducted using a web-based survey for Dutch medical microbiological laboratories (MMLs).
• The survey included 20 case descriptions of LB with laboratory findings, requiring participants to interpret cases and rate LB likelihood.
• Expert-determined baselines were used to score participants' open-ended and multiple-choice responses.

Main Results:

• 38 out of 50 (76%) MMLs participated, achieving an overall mean interpretation score of 8.8/10.
• Scores for multiple-choice questions (9.6/10) were higher than for open-ended interpretations (8.0/10).
• Lower interpretation scores were observed for LB cases with low-incidence manifestations.

Conclusions:

• The EQA demonstrated good interpretation of LB laboratory results in context with clinical information, enhancing participant awareness.
• Further training and education are recommended to improve interpretation skills for LB diagnosis and treatment.
• Future harmonization efforts, potentially including AI-driven clinical support, could enhance LB diagnostic evaluation, especially for rare cases.