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Detecting the Lyme Disease Spirochete, Borrelia Burgdorferi, in Ticks Using Nested PCR
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Published on: February 4, 2018

Clinician Suspicion for Lyme Disease and Clinical Decision-Making in Children with Monoarthritis

Alexandra T Geanacopoulos, Rebecca S Green, Laura L Chapman

    Medrxiv : the Preprint Server for Health Sciences
    |May 18, 2026
    PubMed

    Insights

    Diagnosing Lyme arthritis in children is challenging. Clinician suspicion moderately predicts Lyme disease but doesn't fully distinguish it from septic arthritis, necessitating better diagnostic tools.

    Area of Science:

    • Pediatric infectious diseases
    • Rheumatology
    • Emergency medicine

    Background:

    • Lyme disease is a significant concern in endemic areas, often presenting as monoarthritis in children.
    • Distinguishing Lyme arthritis from septic arthritis is critical due to differing treatment and potential complications.

    Purpose of the Study:

    • To evaluate the diagnostic accuracy of clinician suspicion for Lyme arthritis in children presenting with monoarthritis.
    • To assess the impact of clinician suspicion on clinical decision-making, including invasive procedures, antibiotic use, and hospitalization.

    Main Methods:

    • A large, multi-center cohort study of 1,582 children evaluated for Lyme disease in emergency departments.
    • Analysis of diagnostic accuracy using the area under the receiver operating characteristics curve (AUC).
    • Comparison of treatment and disposition decisions based on clinician suspicion levels.

    Main Results:

    • Lyme arthritis was diagnosed in 39% of children with monoarthritis; septic arthritis occurred in 2%.
    • Clinician suspicion showed moderate discriminative ability for Lyme disease (AUC: 0.75).
    • Higher clinician suspicion correlated with reduced parenteral antibiotics and hospitalization, but not invasive procedures.

    Conclusions:

    • Clinician suspicion has moderate accuracy but is insufficient to reliably differentiate Lyme from septic arthritis in pediatric monoarthritis cases.
    • Current clinical judgment impacts treatment intensity but does not eliminate invasive procedures.
    • Development of improved diagnostic tools is crucial for accurate and timely management of pediatric monoarthritis in Lyme-endemic regions.

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