ArticleJournal of clinical microbiology2019
Evaluation of the Modified Two-Tiered Testing Method for Diagnosis of Lyme Disease in Children.
Article in Journal of clinical microbiology, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 12 papers, 2 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
12 citing papers in PubMed, 2 syntheses or guidelines pooled it, 26 citations in OpenAlex.
- Cutaneous Lyme borreliosis: Guideline of the German Dermatology Society.German medical science : GMS e-journal · 2025Guideline
- Global seroprevalence and sociodemographic characteristics ofBMJ global health · 2022Pooled it
- A customizable multiplex protein microarray for antibody testing and its application for tick-borne and other infectious diseases.Scientific reports · 2025Article
- Real-world Lyme disease testing results using modified vs standard two-tier test protocols.PloS one · 2025Article
- Diagnostic Precision in Lyme borreliosis: Assessing VlsE and C6 Antigens in a Pediatric Cohort.Diagnostics (Basel, Switzerland) · 2023Article
- A Review of Post-treatment Lyme Disease Syndrome and Chronic Lyme Disease for the Practicing Immunologist.Clinical reviews in allergy & immunology · 2022Review
- Laboratory Diagnosis of Lyme Borreliosis.Clinical microbiology reviews · 2021Review
- Lyme Disease Pathogenesis.Current issues in molecular biology · 2021Review
- Performance of a Modified Two-Tiered Testing Enzyme Immunoassay Algorithm for Serologic Diagnosis of Lyme Disease in Nova Scotia.Journal of clinical microbiology · 2020Article
- Expanding Access to Biospecimens for Lyme Disease Test Development.Journal of clinical microbiology · 2020Article
- Modified two-tiered testing algorithm for Lyme disease serology: the Canadian context.Canada communicable disease report = Releve des maladies transmissibles au Canada · 2020Review
- Immunoserological Diagnosis of Human Borrelioses: Current Knowledge and Perspectives.Frontiers in cellular and infection microbiology · 2020Review
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
3 authors at 2 institutions in 1 country.
Funding
Abstract
Conventional two-tiered testing (CTTT) for Lyme disease includes a first-tier enzyme immunoassay (EIA) followed by a supplemental immunoblot, and modified two-tiered testing (MTTT) relies on two different sequential EIAs without the inclusion of an immunoblot. MTTT has shown promising results as an alternative strategy for the diagnosis of Lyme disease in adults but has not yet been evaluated in children. We performed a cross-sectional study of children and adolescents ≤21 years of age undergoing clinical investigation for suspected Lyme disease. Serum specimens were analyzed with both a whole-cell sonicate (WCS) and a C6 EIA, with a supplemental immunoblot if either EIA was positive or equivocal. We compared CTTT (WCS EIA followed by supplemental immunoblot) to MTTT (WCS EIA followed by C6 EIA) using McNemar's test to evaluate for agreement beyond chance alone. We then used a kappa statistic to measure level of the agreement between testing strategies. We included 1,066 serum specimens, of which 156 (14.6%) had a positive CTTT and 165 (15.5%) had a positive MTTT. There were no significant differences between MTTT and CTTT (
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.