Nathaniel Hupert, MD, MPH; Gonzalo M.L. Bearman, MD, MPH; Alvin I. Mushlin, MD, ScM; Mark A. Callahan, MD
Acknowledgments: The authors thank Bruce R. Schackman, PhD, and R. Graham Barr, MD, MPH, for their comments on earlier drafts of this paper and the New York City Department of Health and Mental Hygiene for assistance with Chinese translation.
Grant Support: Drs. Hupert, Mushlin, and Callahan were supported by contract #290-00-0013 from the Agency for Healthcare Research and Quality and by a grant from the Fritz and Adelaide Kauffmann Foundation, New York, New York.
Potential Financial Conflicts of Interest: None disclosed.
Requests for Single Reprints: Nathaniel Hupert, MD, MPH, Department of Public Health, Weill Medical College of Cornell University, 3rd Floor, 411 East 69th Street, New York, NY 10021; e-mail, email@example.com.
Current Author Addresses: Drs. Hupert, Mushlin, and Callahan: Department of Public Health, Weill Medical College of Cornell University, 411 East 69th Street, 3rd Floor, New York, NY 10021.
Dr. Bearman: Department of Epidemiology, Medical College of Virginia–Virginia Commonwealth University, West Hospital, Room 6-202B, 1200 East Broad Street, PO Box 980019, Richmond, VA 23298-0019.
Author Contributions: Conception and design: N. Hupert, G.M.L. Bearman, A.I. Mushlin, M.A. Callahan.
Analysis and interpretation of the data: N. Hupert, G.M.L. Bearman, A.I. Mushlin, M.A. Callahan.
Drafting of the article: N. Hupert, G.M.L. Bearman, A.I. Mushlin, M.A. Callahan.
Critical revision of the article for important intellectual content: N. Hupert, A.I. Mushlin, M.A. Callahan.
Final approval of the article: N. Hupert, G.M.L. Bearman, A.I. Mushlin, M.A. Callahan.
Statistical expertise: N. Hupert, A.I. Mushlin.
Obtaining of funding: N. Hupert, A.I. Mushlin, M.A. Callahan.
Administrative, technical, or logistic support: A.I. Mushlin, M.A. Callahan.
Collection and assembly of the data: N. Hupert, G.M.L. Bearman.
Hupert N, Bearman GM, Mushlin AI, Callahan MA. Accuracy of Screening for Inhalational Anthrax after a Bioterrorist Attack. Ann Intern Med. 2003;139:337-345. doi: 10.7326/0003-4819-139-5_Part_1-200309020-00009
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Published: Ann Intern Med. 2003;139(5_Part_1):337-345.
The 2001 anthrax attacks in the United States, in which 11 people developed the inhalational form of the disease and 5 died, exposed a weakness in the U.S. medical response to bioterrorism (1). Despite heroic efforts on behalf of the victims, physicians were largely unprepared to recognize the early symptoms and signs of this extremely rare and rapidly progressive infection in ambulatory patients (2). Initially, 4 of the 11 patients were sent home after being seen as outpatients or in an emergency department with diagnoses that included “viral syndrome,” bronchitis, and gastroenteritis (3-4). Physicians first considered a diagnosis of anthrax in 2 of these patients (both postal workers) on their second visits to the emergency department and then only after hearing media reports of illness among other postal employees (3).
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Infectious Disease, Pulmonary/Critical Care.
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