{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"institution":[{"name":"medRxiv"}],"indexed":{"date-parts":[[2026,5,11]],"date-time":"2026-05-11T12:08:32Z","timestamp":1778501312850,"version":"3.51.4"},"posted":{"date-parts":[[2026,5,8]]},"group-title":"Pediatrics","reference-count":9,"publisher":"openRxiv","license":[{"start":{"date-parts":[[2026,5,8]],"date-time":"2026-05-08T00:00:00Z","timestamp":1778198400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/www.medrxiv.org\/about\/FAQ#license"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"accepted":{"date-parts":[[2026,5,8]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                <jats:p>In this large multi-center cohort of children evaluated for Lyme disease in a Lyme-endemic emergency department, we assessed the diagnostic accuracy of clinician suspicion and subsequent clinical decision-making for children presenting with monoarthritis. Among 1,582 children with monoarthritis evaluated for Lyme disease, 623 (39%) had Lyme arthritis and 32 (2%) had septic arthritis. Overall, 313 (20%) had an invasive joint procedure (arthrocentesis or arthroscopy), 194 (12%) received parenteral antibiotics, and 376 (24%) were hospitalized. Clinician suspicion had moderate discriminative ability for Lyme disease (area under the receiver operating characteristics curve: 0.75, 95% confidence interval: 0.72-0.77). Children with higher clinician suspicion were less likely to receive parenteral antibiotics or to be hospitalized, although invasive procedure rates were similar. Our findings highlight the challenge of clinically distinguishing Lyme from septic arthritis. Better diagnostic tools are needed to improve timely diagnosis and minimize invasive testing among children with monoarthritis in Lyme-endemic regions.<\/jats:p>","DOI":"10.64898\/2026.05.06.26352605","type":"posted-content","created":{"date-parts":[[2026,5,8]],"date-time":"2026-05-08T14:55:17Z","timestamp":1778252117000},"source":"Crossref","is-referenced-by-count":0,"title":["Clinician Suspicion for Lyme Disease and Clinical Decision-Making in Children with Monoarthritis"],"prefix":"10.64898","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8928-5588","authenticated-orcid":false,"given":"Alexandra T.","family":"Geanacopoulos","sequence":"first","affiliation":[{"name":"Division of Emergency Medicine, Boston Children\u2019s Hospital, Boston, Massachusetts"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rebecca S.","family":"Green","sequence":"additional","affiliation":[{"name":"Division of Emergency Medicine, Children\u2019s Hospital of Philadelphia, Philadelphia, Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Laura L.","family":"Chapman","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Rhode Island Hospital, Providence, Rhode Island"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1927-1682","authenticated-orcid":false,"given":"Desiree N.","family":"Neville","sequence":"additional","affiliation":[{"name":"Division of Emergency Medicine, University of Pittsburgh Medical Center, Children\u2019s Hospital of Pittsburgh, Pittsburgh, Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Meagan M.","family":"Ladell","sequence":"additional","affiliation":[{"name":"Division of Pediatrics, Children\u2019s Hospital of Wisconsin, Milwaukee, Wisconsin"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amy D.","family":"Thompson","sequence":"additional","affiliation":[{"name":"Division of Emergency Medicine, Nemours Children\u2019s Hospital, Wilmington, Delaware"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anupam B.","family":"Kharbanda","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Children\u2019s Minnesota, Minneapolis, Minnesota"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6369-3997","authenticated-orcid":false,"given":"Lise E.","family":"Nigrovic","sequence":"additional","affiliation":[{"name":"Division of Emergency Medicine, Boston Children\u2019s Hospital, Boston, Massachusetts"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"name":"Pedi Lyme Net","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"54368","reference":[{"key":"2026051104151041000_2026.05.06.26352605v1.1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2008-1511"},{"key":"2026051104151041000_2026.05.06.26352605v1.2","doi-asserted-by":"publisher","DOI":"10.1016\/S1521-6942(02)00106-7"},{"key":"2026051104151041000_2026.05.06.26352605v1.3","doi-asserted-by":"publisher","DOI":"10.14745\/ccdr.v40i11a02"},{"key":"2026051104151041000_2026.05.06.26352605v1.4","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2023-061329"},{"key":"2026051104151041000_2026.05.06.26352605v1.5","doi-asserted-by":"publisher","DOI":"10.3201\/eid2612.200920"},{"key":"2026051104151041000_2026.05.06.26352605v1.6","doi-asserted-by":"publisher","DOI":"10.2106\/00004623-199912000-00002"},{"key":"2026051104151041000_2026.05.06.26352605v1.7","doi-asserted-by":"publisher","DOI":"10.1148\/radiology.143.1.7063747"},{"key":"2026051104151041000_2026.05.06.26352605v1.8","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2012-2531"},{"key":"2026051104151041000_2026.05.06.26352605v1.9","doi-asserted-by":"publisher","DOI":"10.1016\/j.annemergmed.2022.04.009"}],"container-title":[],"original-title":[],"link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.64898\/2026.05.06.26352605","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,11]],"date-time":"2026-05-11T11:15:24Z","timestamp":1778498124000},"score":1,"resource":{"primary":{"URL":"http:\/\/medrxiv.org\/lookup\/doi\/10.64898\/2026.05.06.26352605"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,8]]},"references-count":9,"URL":"https:\/\/doi.org\/10.64898\/2026.05.06.26352605","relation":{},"subject":[],"published":{"date-parts":[[2026,5,8]]},"subtype":"preprint"}}