Abstract：
OBJECTIVE: 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.
CONCLUSIONS: 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.
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.
CONCLUSIONS: 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.
摘要：
目标：为了确定诊断机会，我们调查了诊断前28周内莱姆病(LNB)患者的就医行为.
方法：我们以人群为基础，全国匹配的嵌套病例对照研究(丹麦，2009-2021）。作为案例，我们纳入了所有患有LNB(伯氏疏螺旋体鞘内抗体指数检测和脑脊液胞质增多)的丹麦居民.我们从普通人群中随机选择对照组，匹配10:1的出生日期和性别。暴露是症状的诊断代码的分配，联系医学专业，医学流浪，并接受诊断程序。我们计算了每周和3个月暴露个体的比例，并计算了相应的95％置信区间（95CI）的绝对风险差异。
结果：我们包括1,056例LNB和10,560例对照。在诊断前3个月内，最常见的症状是疼痛（差异：13.0%，95CI：10.9-15.1）。LNB病例与大多数专科接触增加，特别是全科医生(差额:48.7%，95CI：46.0-51.4），神经病学（差异：14.3%，95CI：11.7-16.8），和内科(差异:11.1%,95CI：8.7-13.5），和医学流浪（差异：17.1%，95CI：14.3-20.0）。常见的诊断程序包括大脑成像（差异：10.2，95CI：8.3-12.1），脊柱(差异:8.8%,85CI：7.0-10.6），和腹部(差异:7.2%,95CI：5.4-9.1）。在诊断前12周内观察到寻求医疗保健行为的增加。
结论：疼痛似乎是LNB的模糊症状，可能导致延迟建立正确的诊断。由于诊断前增加的寻求医疗保健的行为分布在许多医学专业中，因此很难更有效地识别患有LNB的患者。
方法：我们以人群为基础，全国匹配的嵌套病例对照研究(丹麦，2009-2021）。作为案例，我们纳入了所有患有LNB(伯氏疏螺旋体鞘内抗体指数检测和脑脊液胞质增多)的丹麦居民.我们从普通人群中随机选择对照组，匹配10:1的出生日期和性别。暴露是症状的诊断代码的分配，联系医学专业，医学流浪，并接受诊断程序。我们计算了每周和3个月暴露个体的比例，并计算了相应的95％置信区间（95CI）的绝对风险差异。
结果：我们包括1,056例LNB和10,560例对照。在诊断前3个月内，最常见的症状是疼痛（差异：13.0%，95CI：10.9-15.1）。LNB病例与大多数专科接触增加，特别是全科医生(差额:48.7%，95CI：46.0-51.4），神经病学（差异：14.3%，95CI：11.7-16.8），和内科(差异:11.1%,95CI：8.7-13.5），和医学流浪（差异：17.1%，95CI：14.3-20.0）。常见的诊断程序包括大脑成像（差异：10.2，95CI：8.3-12.1），脊柱(差异:8.8%,85CI：7.0-10.6），和腹部(差异:7.2%,95CI：5.4-9.1）。在诊断前12周内观察到寻求医疗保健行为的增加。
结论：疼痛似乎是LNB的模糊症状，可能导致延迟建立正确的诊断。由于诊断前增加的寻求医疗保健的行为分布在许多医学专业中，因此很难更有效地识别患有LNB的患者。
