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Suspicious Index of Besant et al for Identifying a Patient with High Grade Atrioventricular Block Due to Lyme Carditis (COSTAR)

Description

Besant et al reported a simple score for screening a patient with high degree atrioventricular block for evidence of Lyme carditis. High grade AV block in Lyme carditis may be reversible with appropriate antibiotic therapy. The author are from Queen's University in Kingston, Ontario, Canada.


Acronym: COSTAR

 

Patient selection: high-degree atrioventricular (AV) block

 

Parameters:

(1) constitutional symptoms (C, fever, malaise, arthralgias, dyspnea)

(2) outdoor activities in an endemic area (O)

(3) sex (S)

(4) tick bite (T)

(5) age in years (A)

(6) rash (R, erythema migrans)

 

Parameters

Finding

Points

constitutional symptoms

no

0

 

yes

2

outdoor activities

no

0

 

yes

1

sex

male

1

 

female

0

tick bite

no

0

 

yes

3

age in years

< 50 years

1

 

>= 50 years

0

erythema migrans

no

0

 

yes

4

 

total score =

= SUM(points for all 6 parameters)

 

Interpretation:

• minimum score: 0

• maximum score: 12

• The higher the score the greater the likelihood of underlying Lyme carditis.

 

Total Score

Suspicion for Lyme's Disease

0 to 2

low

3 to 6

intermediate

7 to 12

high

 


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