title: Performance of an algorithm for assessing smallpox risk among patients with rashes that may be confused with smallpox.
abstract: After the 2001 anthrax bioterror attacks, the Centers for Disease Control and Prevention developed an algorithm to evaluate patients rapidly for suspected smallpox. A prospective, multicenter study examined the performance of this algorithm in assessing patients with an acute, generalized vesicular or pustular rash (AGVPR) admitted to emergency departments and inpatient units of 12 acute-care hospitals in 6 states. Of 26,747 patients (3.5% of all admissions) with rashlike conditions screened, 89 (1.2 patients per 10,000 admissions) had an AGVPR. Physicians or study staff classified none of 73 enrolled patients as being at high risk for having smallpox; 72 (99%) were classified as being at low risk, and 1 was classified as being at moderate risk. The discharge diagnosis for 55 (75%) of these 73 participants was varicella illness. Use of the algorithm did not result in misclassification of AGVPR as high risk for smallpox. The algorithm is a highly specific tool for clinical evaluation of suspected smallpox disease.
authors.affiliation: National Immunization Program, Centers for Disease Control and Prevention, Atlanta, Georgia, USA. ssh1@cdc.gov
authors.forename: Sonja S
authors.initials: SS
authors.lastname: Hutchins
authors.forename: Iddrisu
authors.initials: I
authors.lastname: Sulemana
authors.forename: Katherine L
authors.initials: KL
authors.lastname: Heilpern
authors.forename: William
authors.initials: W
authors.lastname: Schaffner
authors.forename: Gary
authors.initials: G
authors.lastname: Wax
authors.forename: E Brooke
authors.initials: EB
authors.lastname: Lerner
authors.forename: Barbara
authors.initials: B
authors.lastname: Watson
authors.forename: Robert
authors.initials: R
authors.lastname: Baltimore
authors.forename: Rachel A
authors.initials: RA
authors.lastname: Waltenburg
authors.forename: Dominik
authors.initials: D
authors.lastname: Aronsky
authors.forename: Susan
authors.initials: S
authors.lastname: Coffin
authors.forename: Gladys
authors.initials: G
authors.lastname: Ng
authors.forename: Allen S
authors.initials: AS
authors.lastname: Craig
authors.forename: Amy
authors.initials: A
authors.lastname: Behrman
authors.forename: James
authors.initials: J
authors.lastname: Meek
authors.forename: Eileen
authors.initials: E
authors.lastname: Sherman
authors.forename: Sandra S
authors.initials: SS
authors.lastname: Chavez
authors.forename: Rafael
authors.initials: R
authors.lastname: Harpaz
authors.forename: Scott
authors.initials: S
authors.lastname: Schmid
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D002648:Child; D002675:Child, Preschool; D003937:Diagnosis, Differential; D004189:Disaster Planning; D004196:Disease Outbreaks / Q000517:prevention & control*; D005076:Exanthema / Q000209:etiology / Q000821:virology*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D011446:Prospective Studies; D012899:Smallpox / Q000175:diagnosis*; D014481:United States