Integrating spatial epidemiology into a decision model for evaluation of facial palsy in children

Arch Pediatr Adolesc Med. 2011 Jan;165(1):61-7. doi: 10.1001/archpediatrics.2010.250.


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 <20 years) with peripheral facial palsy who were evaluated for Lyme disease.

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.

Publication types

  • Comparative Study
  • Evaluation Study
  • Research Support, N.I.H., Extramural
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adolescent
  • Analysis of Variance
  • Boston / epidemiology
  • Child
  • Child, Preschool
  • Cohort Studies
  • Confidence Intervals
  • Decision Support Techniques*
  • Emergency Service, Hospital
  • Facial Paralysis / diagnosis*
  • Facial Paralysis / epidemiology*
  • Female
  • Hospitals, Pediatric
  • Humans
  • Incidence
  • Linear Models
  • Lyme Disease / diagnosis*
  • Lyme Disease / epidemiology*
  • Male
  • Massachusetts / epidemiology
  • Multivariate Analysis
  • Odds Ratio
  • Predictive Value of Tests
  • Reproducibility of Results
  • Retrospective Studies
  • Risk Assessment
  • Severity of Illness Index
  • Young Adult