• Lise E Nigrovic, Keri A Cohn, Todd W Lyons, Amy D Thompson, Elizabeth M Hines, Elizabeth J Welsh, and Samir S Shah.
• Division of Emergency Medicine, Boston Children's Hospital, Boston, MA 02115, USA.
• J Emerg Med. 2013 Jun 1;44(6):1196-200.

BackgroundIn Lyme disease-endemic areas, many children with aseptic meningitis are hospitalized while awaiting Lyme serology results. Although Lyme serology takes several days, an enteroviral polymerase chain reaction (EV PCR) test takes only a few hours to return results.ObjectiveOur aim was to measure the impact of EV PCR testing on duration of stay for children evaluated for Lyme meningitis.MethodsA retrospective cohort study was performed with children evaluated for Lyme meningitis at 3 Emergency Departments located in Lyme disease-endemic areas. We defined Lyme meningitis using the Centers for Disease Control and Prevention criteria (either positive Lyme serology test result or an erythema migrans rash). The duration of stay was compared by EV PCR test result (positive, negative, and not obtained).ResultsThere were 423 study patients identified, 117 (28%) of whom had Lyme meningitis and 209 (49%) had an EV PCR test performed. Median length of stay varied by the EV PCR test status: children with a positive EV PCR test (n = 103; 28 h; interquartile range 17-48 h), those with a negative EV PCR test (n = 106; 72 h; interquartile range 48-120 h), and those who did not have an EV PCR test obtained (n = 214; 48 h; interquartile range 24-96 h; p ≤ 0.001).ConclusionsRapid EV PCR testing could assist clinical decision making by Emergency Physicians, avoiding potentially unnecessary hospitalization and parenteral antibiotics for children at low risk of Lyme meningitis.Copyright © 2013 Elsevier Inc. All rights reserved.

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