title: Screening for inhalational anthrax due to bioterrorism: evaluating proposed screening protocols.
abstract: Eleven known cases of bioterrorism-related inhalational anthrax (IA) were treated in the United States during 2001. We retrospectively compared 2 methods that have been proposed to screen for IA. The 2 screening protocols for IA were applied to the emergency department charts of patients who presented with possible signs or symptoms of IA at Inova Fairfax Hospital (Falls Church, Virginia) from 20 October 2001 through 3 November 2001. The Mayer criteria would have screened 4 patients (0.4%; 95% CI, 0.1%-0.9%) and generated charges of 1900 dollars. If 29 patients (2.6%; 95% CI, 1.7%-3.7%) with >or=5 symptoms (but without fever and tachycardia) were screened, charges were 13,325 dollars. The Hupert criteria would have screened 273 patients (24%; 95% CI, 22%-27%) and generated charges of 126,025 dollars. In this outbreak of bioterrorism-related IA, applying the Mayer criteria would have identified both patients with IA and would have generated fewer charges than applying the Hupert criteria.
authors.affiliation: Department of Emergency Medicine, Inova Fairfax Hospital, Falls Church, VA 22042-3300, USA. john.howell@inova.com
authors.forename: John M
authors.initials: JM
authors.lastname: Howell
authors.forename: Thom A
authors.initials: TA
authors.lastname: Mayer
authors.forename: Dan
authors.initials: D
authors.lastname: Hanfling
authors.forename: Allan
authors.initials: A
authors.lastname: Morrison
authors.forename: Glenn
authors.initials: G
authors.lastname: Druckenbrod
authors.forename: Cecele
authors.initials: C
authors.lastname: Murphy
authors.forename: Robert
authors.initials: R
authors.lastname: Cates
authors.forename: Denis
authors.initials: D
authors.lastname: Pauze
mesh_terms: D000328:Adult; D000881:Anthrax / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000191:economics / Q000453:epidemiology; D001694:Biological Warfare; D023482:Bioterrorism; D004196:Disease Outbreaks; D004318:Doxycycline / Q000627:therapeutic use; D042241:Early Diagnosis; D006801:Humans; D001239:Inhalation; D008403:Mass Screening; D011859:Radiography; D012189:Retrospective Studies; D014768:Virginia
chemical_list: D004318:Doxycycline