Post by Admin/ Traveler on Feb 28, 2019 16:29:24 GMT
Lyme Disease Overdiagnosis in a Large Healthcare System: A Population-based, Retrospective Study.
Webber BJ, Burganowski RP, Colton L, Escobar JD, Pathak SR, Gambino-Shirley KJ.
"Abstract
OBJECTIVES:
To evaluate the impact of false positive IgM immunoblots on Lyme disease treatment and case reporting in a large healthcare system.
METHODS:
We obtained results of all Lyme disease serologic tests ordered at U.S. Air Force healthcare facilities in the United States between January 2013 and December 2017. We conducted chart reviews to adjudicate positive IgM immunoblots (from two-tier and independent testing) as true positives or false positives using established criteria, and we assessed whether these cases were reported to the U.S. Department of Defense surveillance system.
RESULTS:
Of the 18,410 serum tests (17,058 immunoassays and 1,352 immunoblots) performed on 15,928 unique persons, 249/1,352 (18.4%) IgM immunoblots were positive. After excluding repeat tests, insufficiently documented cases, and subjects with a history of Lyme disease, 212 positive IgM immunoblot cases were assessed. A total of 113/212 (53.3%) were determined to be false positives. Antibiotics were prescribed for Lyme disease for 97/99 (98.0%) subjects with a true positive test and 91/113 (80.5%) subjects with a false positive test. The number of false positive cases reported to the surveillance system was identical to the number of unreported true positive cases (n=44).
CONCLUSIONS:
Lyme disease serological tests were overutilized in a large healthcare system, and positive results were frequently misinterpreted, leading to misdiagnosis and widespread antibiotic misuse. Underreporting of true positive cases was offset by overreporting of false positive cases, suggesting that the discrepancy between the reported incidence and true incidence of Lyme disease may not be as significant as previously assumed."
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So, let's go over this, shall we?
I was actually concerned that we had reached a new finding, but then I saw this:
"We conducted chart reviews to adjudicate positive IgM immunoblots (from two-tier and independent testing) as true positives or false positives using established criteria..." I actually cussed under my breath. Them and their "established criteria" - right - you mean the one that they shoved down our throats and that they have no basis to continue to stand on this 'criteria' because it's been proven wrong time and time again?? That one, right?? (yes, I'm just being incredibly sarcastic here).
BUT - let's not skip the things that just 'top this off'!!!
"After excluding repeat tests, insufficiently documented cases, and subjects with a history of Lyme disease..." Yes, because we KNOW that they can't still have Lyme, right - or even be reinfected. The IDSA has proven this beyond a shadow of a doubt, right??? (again, I'm so very mad and sarcastic here!)
" A total of 113/212 (53.3%) were determined to be false positives." Boy, that's awful funny - that's right close to the amount of false negatives that are reported by UNBIASED publications. I think I see a pattern here......
Maybe, just maybe a more sensitive and accurate test would help?? Oh, no, we couldn't have that - even though they are in existence right now.
(PS, sorry to the members here!!)
Webber BJ, Burganowski RP, Colton L, Escobar JD, Pathak SR, Gambino-Shirley KJ.
"Abstract
OBJECTIVES:
To evaluate the impact of false positive IgM immunoblots on Lyme disease treatment and case reporting in a large healthcare system.
METHODS:
We obtained results of all Lyme disease serologic tests ordered at U.S. Air Force healthcare facilities in the United States between January 2013 and December 2017. We conducted chart reviews to adjudicate positive IgM immunoblots (from two-tier and independent testing) as true positives or false positives using established criteria, and we assessed whether these cases were reported to the U.S. Department of Defense surveillance system.
RESULTS:
Of the 18,410 serum tests (17,058 immunoassays and 1,352 immunoblots) performed on 15,928 unique persons, 249/1,352 (18.4%) IgM immunoblots were positive. After excluding repeat tests, insufficiently documented cases, and subjects with a history of Lyme disease, 212 positive IgM immunoblot cases were assessed. A total of 113/212 (53.3%) were determined to be false positives. Antibiotics were prescribed for Lyme disease for 97/99 (98.0%) subjects with a true positive test and 91/113 (80.5%) subjects with a false positive test. The number of false positive cases reported to the surveillance system was identical to the number of unreported true positive cases (n=44).
CONCLUSIONS:
Lyme disease serological tests were overutilized in a large healthcare system, and positive results were frequently misinterpreted, leading to misdiagnosis and widespread antibiotic misuse. Underreporting of true positive cases was offset by overreporting of false positive cases, suggesting that the discrepancy between the reported incidence and true incidence of Lyme disease may not be as significant as previously assumed."
-------------------------------------------------------------------------------------------------------------------------------------------------------------
So, let's go over this, shall we?
I was actually concerned that we had reached a new finding, but then I saw this:
"We conducted chart reviews to adjudicate positive IgM immunoblots (from two-tier and independent testing) as true positives or false positives using established criteria..." I actually cussed under my breath. Them and their "established criteria" - right - you mean the one that they shoved down our throats and that they have no basis to continue to stand on this 'criteria' because it's been proven wrong time and time again?? That one, right?? (yes, I'm just being incredibly sarcastic here).
BUT - let's not skip the things that just 'top this off'!!!
"After excluding repeat tests, insufficiently documented cases, and subjects with a history of Lyme disease..." Yes, because we KNOW that they can't still have Lyme, right - or even be reinfected. The IDSA has proven this beyond a shadow of a doubt, right??? (again, I'm so very mad and sarcastic here!)
" A total of 113/212 (53.3%) were determined to be false positives." Boy, that's awful funny - that's right close to the amount of false negatives that are reported by UNBIASED publications. I think I see a pattern here......
Maybe, just maybe a more sensitive and accurate test would help?? Oh, no, we couldn't have that - even though they are in existence right now.
(PS, sorry to the members here!!)