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Of 1770 children undergoing emergency department evaluation for Lyme disease, 362 (20.5%) children had Lyme disease. Of those with an available tick bite history, only a minority of those with Lyme disease had a recognized tick bite (60/325; 18.5%, 95% confidence interval 14.6-23.0%). Lack of a tick bite history does not reliably exclude Lyme disease.

Published in Science Direct: https://www.sciencedirect.com/science/article/abs/pii/S1877959X18304965?via%3Dihub 
PubMed: https://www.ncbi.nlm.nih.gov/pubmed/30853264