Healthcare-seeking behaviour preceding diagnosis of Lyme neuroborreliosis: population-based nationwide matched nested case-control study.

IF 10.9 1区医学 Q1 INFECTIOUS DISEASES Clinical Microbiology and Infection Pub Date : 2024-07-09 DOI:10.1016/j.cmi.2024.07.004

Malte M Tetens, Lars Haukali Omland, Nanna S Andersen, Jette Bangsborg, Jacob Bodilsen, Ram B Dessau, Svend Ellermann-Eriksen, Charlotte Sværke Jørgensen, Jens Kjølseth Møller, Alex Christian Yde Nielsen, Michael Pedersen, Kirstine K Søgaard, Niels Obel, Anne-Mette Lebech

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Abstract

Objectives: To identify diagnostic opportunities, we investigated healthcare-seeking behaviour among patients with Lyme neuroborreliosis (LNB) within 28 weeks before diagnosis.

Methods: We conducted a population-based, nationwide matched nested case-control study (Denmark, 2009-2021). As cases, we included all Danish residents with LNB (positive Borrelia burgdorferi intrathecal antibody index test and cerebrospinal fluid pleocytosis). We randomly selected controls from the general population and matched 10:1 on date of birth and sex. Exposures were assignment of diagnostic codes for symptoms, contact to medical specialties, medical wandering, and undergoing diagnostic procedures. We calculated the weekly and 3-month proportions of individuals with exposures and calculated absolute risk differences with corresponding 95% CI.

Results: We included 1056 cases with LNB and 10 560 controls. Within 3 months before diagnosis, the most frequent assigned symptoms were pain (difference: 13.0%, 95% CI: 10.9-15.1). Cases with LNB exhibited increased contact with most specialties, particularly general practitioners (difference: 48.7%, 95% CI: 46.0-51.4), neurology (difference: 14.3%, 95% CI: 11.7-16.8), and internal medicine (difference: 11.1%, 95% CI: 8.7-13.5), and medical wandering (difference: 17.1%, 95% CI: 14.3-20.0). Common diagnostic procedures included imaging of the brain (difference: 10.2, 95% CI: 8.3-12.1), the spine (difference: 8.8%, 85% CI: 7.0-10.6), and the abdomen (difference: 7.2%, 95% CI: 5.4-9.1). The increase in healthcare-seeking behaviour was observed ≤12 weeks preceding diagnosis.

Discussion: Pain appears to be an ambiguous symptom of LNB, potentially contributing to delays in establishing the correct diagnosis. It would be difficult to identify patients with LNB more effectively as the increased healthcare-seeking behaviour preceding diagnosis is distributed across many medical specialties.

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莱姆神经源性疾病确诊前的就医行为：基于人群的全国性匹配巢式病例对照研究。

目的：为了确定诊断机会，我们调查了莱姆神经源性疾病（LNB）患者在诊断前 28 周内的就医行为：为了确定诊断机会，我们调查了莱姆神经源性疾病（LNB）患者在确诊前 28 周内的就医行为：我们开展了一项基于人口的全国性匹配巢式病例对照研究（丹麦，2009-2021 年）。作为病例，我们纳入了所有患有 LNB 的丹麦居民（包氏杆菌鞘内抗体指数测试和脑脊液多细胞症阳性）。我们从普通人群中随机抽取了对照组，出生日期和性别的匹配比例为 10:1。暴露情况包括症状的诊断代码分配、与医学专科的接触、医疗流浪以及接受诊断程序。我们计算了每周和 3 个月内有暴露的个人比例，并计算了绝对风险差异及相应的 95% 置信区间 (95%CI)：我们纳入了 1,056 例 LNB 患者和 10,560 例对照。在确诊前 3 个月内，最常见的症状是疼痛（差异：13.0%，95%CI：10.9-15.1）。患有 LNB 的病例与大多数专科的联系都有所增加，尤其是全科医师（差异：48.7%，95%CI：46.0-51.4）、神经内科（差异：14.3%，95%CI：11.7-16.8）、内科（差异：11.1%，95%CI：8.7-13.5）和医学游荡（差异：17.1%，95%CI：14.3-20.0）。常见的诊断程序包括脑部成像（差异：10.2，95%CI：8.3-12.1）、脊柱成像（差异：8.8%，85%CI：7.0-10.6）和腹部成像（差异：7.2%，95%CI：5.4-9.1）。就医行为的增加在确诊前的 12 周内即可观察到：疼痛似乎是 LNB 的一个模糊症状，有可能导致延误正确诊断。很难更有效地识别 LNB 患者，因为诊断前就医行为的增加分布在许多医学专科。

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来源期刊

Clinical Microbiology and Infection 医学-传染病学

CiteScore

25.30

自引率

2.10%

发文量

441

审稿时长

2-4 weeks

期刊介绍： Clinical Microbiology and Infection (CMI) is a monthly journal published by the European Society of Clinical Microbiology and Infectious Diseases. It focuses on peer-reviewed papers covering basic and applied research in microbiology, infectious diseases, virology, parasitology, immunology, and epidemiology as they relate to therapy and diagnostics.