title: Performance of a rapid dermatology referral system during the anthrax outbreak.
abstract: The bioterrorism-related anthrax outbreak generated unanticipated demand for dermatologic services. In this study we sought to perform rapid, efficient, cost-effective evaluation of patients suspected of having cutaneous anthrax. During the outbreak, we developed an anthrax evaluation system featuring clinical field examination by nondermatologist physicians, followed by rapid referral of selected high-risk patients to a centralized dermatology center. We excluded anthrax in 29 previously screened high-risk patients. All were examined within 24 hours, costing $272.07 per patient. Diagnoses were established quickly (median, same day; range, 0-15 days). Among 2259 at-risk postal workers, 144 (6.4%) self-identified new (< or =14 days) skin lesions and were examined in the field; 8 (5.6%) were referred to our system. Our system was not the only local dermatologic resource available during the outbreak. A system featuring initial nondermatologist examination with minimal laboratory evaluation, followed by rapid centralized referral of high-risk patients, functioned efficiently in this outbreak.
authors.affiliation: Epidemic Intelligence Service, Division of Applied Public Health Training, Epidemiology Program Office, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA. john.redd@ihs.gov
authors.forename: John T
authors.initials: JT
authors.lastname: Redd
authors.forename: Chris
authors.initials: C
authors.lastname: Van Beneden
authors.forename: Nicholas A
authors.initials: NA
authors.lastname: Soter
authors.forename: Eric
authors.initials: E
authors.lastname: Hatzimemos
authors.forename: David E
authors.initials: DE
authors.lastname: Cohen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000881:Anthrax / Q000175:diagnosis* / Q000453:epidemiology*; D023482:Bioterrorism; D002648:Child; D003880:Dermatology / Q000458:organization & administration*; D004196:Disease Outbreaks; D005260:Female; D006301:Health Services Needs and Demand; D006801:Humans; D008297:Male; D008875:Middle Aged; D012017:Referral and Consultation / Q000458:organization & administration*; D013997:Time Factors